Manager, Revenue Cycle Management

Job Description

Job Description

General Summary

A results-driven Revenue Cycle Manager will lead day-to-day revenue cycle operations across Workers’ Compensation, Personal Injury, and Pharmacy claims. This role will be responsible for driving collections, reducing aged accounts receivable, improving payer follow-up, managing denials and appeals, and ensuring collectors are working accounts based on the highest opportunity for reimbursement.

The Revenue Cycle Manager will directly oversee collector performance and work closely with both onshore and offshore resources. This individual must be comfortable working in a high-volume environment with a significant outstanding AR inventory and must be able to use data to identify problems, prioritize accounts, and drive measurable improvements in cash collections. This is a hands-on management position. The successful candidate will be expected to understand the details behind the numbers, identify barriers to payment, coach the team, and escalate payer or operational issues before they negatively impact cash.

Primary / Key Essential Functions and Responsibilities

Revenue Cycle Operations

· Manage daily revenue cycle and collection activities across Workers’ Compensation, Personal Injury, and Pharmacy accounts.

· Drive achievement of weekly and monthly cash collection targets.

· Monitor AR by payer, state, client, aging category, balance, claim status, and denial reason.

· Develop targeted strategies for high-dollar and aged accounts.

· Ensure collectors prioritize accounts based on collectability, reimbursement opportunity, aging, and payer requirements.

· Identify accounts requiring corrected claims, resubmissions, reconsiderations, appeals, medical records, authorization documentation, or payer escalation.

· Ensure timely and appropriate follow-up on unpaid and underpaid claims.

· Monitor claims with no payer response and establish escalation strategies to determine claim status and secure reimbursement.

· Partner with leadership on initiatives to improve electronic claim submission and reduce reliance on untracked manual processes.

Cash & AR Management

· Establish daily, weekly, and monthly collection expectations for the team.

· Monitor actual collections against established cash targets.

· Identify trends contributing to cash shortfalls and develop corrective action plans.

· Reduce aging, particularly accounts greater than 90, 120, and 180 days.

· Identify high-value AR opportunities and ensure resources are appropriately assigned.

· Evaluate expected reimbursement versus billed charges and actual payments to identify underpayments.

· Monitor unresolved payer balances and ensure timely escalation.

· Provide accurate cash forecasts and AR risk assessments to the Vice President of Revenue Cycle.

Payer Management

· Develop payer-specific collection strategies based on claim volume, outstanding AR, reimbursement trends, and payment behavior.

· Identify systemic payer issues impacting reimbursement.

· Track payer denials, underpayments, no-response claims, and recurring processing issues.

· Coordinate payer escalations when standard collection activity is unsuccessful.

· Work with internal leadership and external payer contacts to resolve significant outstanding balances.

· Maintain knowledge of Workers’ Compensation payer requirements, timely filing requirements, documentation requirements, fee schedules, and appeal processes.

· Identify reimbursement trends requiring contractual, legal, regulatory, or executive escalation.

Team Leadership

· Provide direct leadership and accountability for Revenue Cycle collectors and support staff.

· Manage both onshore and offshore collection resources.

· Establish clear productivity and quality expectations.

· Conduct regular team meetings and individual performance reviews.

· Review collector work queues and ensure accounts are being worked according to established priorities.

· Coach employees on payer strategy, claim research, appeals, documentation, and effective collection techniques.

· Recognize top performers and develop employees with growth potential.

· Identify persistent performance deficiencies and implement documented performance improvement plans when necessary.

· Ensure staffing and workload distribution align with AR volume and collection opportunities.

Analytics & Reporting

· Daily cash collection results

· Weekly cash performance

· Monthly collections against target

· AR aging by payer and state

· Collector productivity and performance

· Claims worked per day

· Dollars collected per collector

· Collection rate

· No-response inventory

· Denial volume and denial trends

· Underpayment inventory

· Appeal volume and outcomes

· High-dollar outstanding claims

· Payer-specific performance

· Onshore versus offshore performance

· Accounts approaching timely filing or appeal deadlines

Process Improvement

· Evaluate current Capture workflows and identify opportunities to eliminate unnecessary manual work, delays, and duplicate effort.

· Standardize onboarding and EMR access processes.

· Develop SOPs and training materials for Capture Report management and EMR access.

· Implement workflow improvements designed to increase productivity and reduce escalations.

· Partner with Revenue Cycle, Operations, IT, and clinic teams to improve communication and service delivery.

· Develop appropriate escalation pathways so issues are resolved at the correct level without unnecessary leadership involvement.

Education and/or Experience and Qualifications

Minimum Education: Bachelors’ degree required; Masters’ degree preferred.

Minimum Experience: - 5+ years of healthcare revenue cycle, collections, reimbursement, or accounts receivable experience. 2+ years of management or supervisory experience within Revenue Cycle Management.

· Demonstrated experience managing high-volume healthcare AR.

· Strong knowledge of claim follow-up, denials, appeals, underpayments, and payer reimbursement.

· Experience managing and coaching collection teams.

· Strong analytical skills with the ability to interpret AR and collection data.

· Demonstrated ability to establish KPIs and hold teams accountable for measurable results.

Preferred

· Workers’ Compensation revenue cycle experience strongly preferred.

· Pharmacy or prescription claims experience.

· Personal Injury/PIP experience.

· Experience managing payer-specific collection teams.

· Experience managing offshore revenue cycle resources.

· Experience with both electronic and paper claim environments.

· Experience managing large, aged AR cleanup initiatives.

· Knowledge of state-specific Workers’ Compensation billing and reimbursement requirements.

· Experience working with third-party administrators, PBMs, Workers’ Compensation carriers, and commercial payers.

Knowledge, Skills and Abilities

· Advanced proficiency with Excel and revenue cycle reporting.

· Strong communication within all levels of the organization, problem-solving, and organizational skills.

· Strong ownership and accountability

· Urgency around cash and AR

· Data-driven decision-making

· Ability to identify root causes rather than simply report problems

· Strong negotiation and escalation skills

· Ability to lead through operational change

· Effective coaching and performance management

· Ability to manage competing priorities

· Willingness to work directly in the details when necessary

Financial Responsibility

Yes

Management / Supervisory Authority

Yes

Physical Requirements

The physical requirements listed are representative of those necessary to perform the essential functions of the position. Depending on the role, employees may be required to sit, stand, walk, reach, handle or operate equipment, and occasionally bend, stoop, kneel, crouch, crawl, or lift and/or move up to 25 pounds.

Reasonable accommodation will be provided to qualified individuals with disabilities, as required by applicable law, to enable them to perform the essential functions of the position. External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job functions either unaided or with assistance of a reasonable accommodation as determined on a case-by-case basis.

Standard Specifications

This job description describes the general nature and level of work and is not intended to be an exhaustive list of all duties, responsibilities, or requirements. Duties and responsibilities may change based on business needs. Employees may be assigned other job-related duties as needed.

This description does not create an employment contract, express or implied, or alter an at-will employment relationship, where applicable.

Equal Employment Opportunity

Advanced Rx Management LLC is an Equal Employment Opportunity (EEO) employer. We are committed to providing equal employment opportunities to all qualified applicants and employees without regard to legally protected characteristics under applicable federal, state, or local law. We provide reasonable accommodation to qualified individuals with disabilities and for other legally protected needs, as required by applicable law.