RCM & Compliance Manager

RCM & Compliance Manager

Essen Health Care is looking for a results driven RCM & Compliance Manager to lead and strengthen revenue cycle operations and regulatory compliance across our Nursing Home and Hospitalist divisions. This is not a back office support role. It is a strategic leadership position where you will directly influence how Essen captures revenue, maintains documentation integrity, and upholds the highest standards of care quality.

You will serve as the bridge between clinical documentation and financial performance, making sure our providers are documenting accurately, our claims are clean, and our compliance posture protects both patients and the organization. Reporting to senior leadership, this role carries real ownership and visibility across divisions.

At Essen, our mission is to innovate the healthcare delivery system and provide the most vulnerable communities access to the highest quality care. This role is essential to making that mission financially sustainable.

Responsibilities

E&M Documentation & Compliance Oversight

• Conduct regular E&M documentation audits across nursing home and hospitalist providers to ensure accuracy, completeness, and alignment with CMS guidelines.
• Identify documentation gaps, upcoding/downcoding trends, and provider specific patterns that require targeted education or corrective action.
• Develop and deliver provider training on E&M coding requirements, medical necessity standards, and documentation best practices for long term care and inpatient encounters.
• Monitor regulatory changes related to E&M coding (including split/shared visit rules) and update internal compliance protocols accordingly.

Care Quality Audits

• Lead and conduct care quality audits across nursing home facilities and hospitalist service lines, evaluating clinical documentation against established quality benchmarks.
• Collaborate with medical directors, nursing leadership, and clinical teams to translate audit findings into actionable improvement plans.
• Track and trend audit results over time, reporting outcomes to senior leadership with clear recommendations for operational and clinical improvements.
• Ensure audit processes meet or exceed CMS Conditions of Participation, state survey readiness standards, and internal quality benchmarks.

Revenue Cycle Management (RCM)

• Oversee and improve RCM workflows from claims submission through final adjudication, with a focus on reducing denials and accelerating collections.
• Review and QA claims submissions for accuracy before release, ensuring proper coding, modifiers, and supporting documentation are in place.
• Lead denial management and appeals processes, conducting root cause analysis on denial trends and implementing systemic fixes to prevent recurrence.
• Monitor pending insurance claims and aging reports, driving timely follow up and resolution of outstanding balances.
• Coordinate retrieval and follow up of missing documentation required for claims processing, working closely with clinical and administrative teams to close documentation gaps.
• Track key RCM performance metrics (denial rates, days in A/R, clean claim rates, collection percentages) and report regularly to leadership with variance analysis and action plans.

Process Improvement & Cross Functional Collaboration

• Identify and execute process improvement opportunities across both compliance and RCM workflows, eliminating inefficiencies and reducing revenue leakage.
• Serve as the primary liaison between clinical operations, billing, coding, and administrative teams to ensure alignment on documentation requirements and billing protocols.
• Support payer audits, RAC audits, and internal investigations by preparing documentation, coordinating responses, and managing timelines.
• Stay current on federal and state regulations affecting long term care billing, hospitalist services, Medicare/Medicaid reimbursement, and value based care models.

Qualifications

Experience in revenue cycle management, compliance, or coding operations within a nursing home, long term care, or hospitalist setting.

CPC certification (AAPC) preferred, or equivalent coding/compliance credentials (CCS, CPMA, CHC).

Strong working knowledge of E&M coding, medical record auditing, and CMS billing regulations for skilled nursing facilities and hospitalist services.

Demonstrated experience with denial management, claims review, appeals, and payer relations.

Proficiency with EHR systems commonly used in long term care and hospitalist environments, including Sigmacare, PointClickCare, Wellsky, Visual, Epic, and/or Allscripts.

Familiarity with Medicare Part A/B billing, MDS/RUG classifications, and Medicaid reimbursement models.

Strong analytical skills with the ability to interpret claims data, audit results, and financial reports to drive decision making.

Excellent communication and interpersonal skills, with the ability to collaborate effectively across clinical, administrative, and executive teams.

Bachelor's degree in Health Administration, Business, or a related field preferred.

Experience building or optimizing RCM workflows from the ground up in a growing healthcare organization.

Background in provider education and one on one coding feedback sessions.

Working knowledge of value based care arrangements and quality reporting programs (MIPS, HEDIS, Star Ratings).

Project management ability, comfortable managing multiple concurrent priorities across facilities and service lines.

Familiarity with compliance program frameworks (OIG guidance, corporate integrity agreements, internal monitoring plans).

Bilingual (English/Spanish) is a plus given the patient populations served across Essen's network.

Impact of the Role

This is a position where your work has a direct, measurable effect on the financial health and regulatory standing of Essen's Nursing Home and Hospitalist operations. When you strengthen documentation accuracy, clean claim rates go up. When you close compliance gaps before they become audit findings, you protect the organization. When you streamline the revenue cycle, you help ensure Essen has the resources to continue delivering care to some of New York's most underserved communities.

You will work alongside clinical leaders, billing teams, and executive stakeholders, not in a silo. Your insights will shape provider education, inform operational strategy, and directly contribute to Essen's growth as one of New York's premier healthcare organizations.

If you want to be somewhere your expertise actually drives change, and where the leadership team genuinely values compliance as a strategic function rather than a checkbox, this is the role.

Equal Opportunity Employer

Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.