Revenue Cycle Manager/Utilization Management

Job Description

Job Description:\n\n Anuvia Prevention & Recovery Center | Confidential Job Posting NOW HIRING Revenue Cycle Manager — Standard Business Hours • Revenue Cycle • Founding Leadership Role Monday – Friday, 8:00 AM – 5:00 PM • On-Site, Main Campus, Charlotte, NC Department Revenue Cycle Functional Area Utilization Management • Payer Operations • Front-End Revenue Cycle Reports To Chief Operating Officer FLSA Status Salary / Exempt Certification CRCR (Certified Revenue Cycle Representative) preferred Education Bachelor's degree preferred (or equivalent experience) License Valid NC or SC Driver's License required Work Hours Monday – Friday, 8:00 AM – 5:00 PM (occasional extended hours as needed) “The Revenue Cycle Manager builds and leads Anuvia's payer-to-cash cycle — protecting revenue, driving intake accuracy, and standing up the operational, technical, and training backbone that keeps every client's access to care intact.” Position Summary The Revenue Cycle Manager is a founding leadership role at Anuvia Prevention & Recovery Center, responsible for standing up the organization's Revenue Cycle function and leading its day-to-day operations. Reporting directly to the Chief Operating Officer, the Revenue Cycle Manager owns the end-to-end revenue cycle — from intake accuracy through clean-claim submission — and builds the operational, technical, and training backbone that protects Anuvia's revenue and every client's access to care. To perform this job successfully, an individual must be able to perform the following satisfactorily; other duties may be assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Essential Duties & Responsibilities Utilization Management & Authorizations Own end-to-end Utilization Management for Medicaid MCO, Medicare, and commercial payer work across all programs and locations.Direct submission and tracking of all initial authorization requests for inpatient admissions and outpatient services.Own end-to-end reauthorization work for programs with high-frequency administrative reauthorization requirements — including but not limited to Residential Treatment, SACOT, and IOP — from initial authorization through renewal and continued stay. Scope expands as new programs, payers, or authorization rules are added.Route medical-necessity reauthorizations for other programs to Clinical at least 5 business days before expiration.Maintain the authorization system of record in NetSmart — payer, units, dates, reference numbers, and expiration alerts — for every active authorization.Coordinate peer-to-peer review scheduling for denied authorizations; Clinical conducts the review. Intake Paperwork Review & Cross-Functional Partnership Oversee centralized daily review of prior-day intake paperwork submitted from every Anuvia location; review completed by 10:30 AM the next business day.Partner with the Front-Desk / Admin working lead and clinical intake staff to define intake standards, drive paperwork quality, and remediate errors — holding functional accountability for intake accuracy across every site.Publish a monthly intake-accuracy scorecard by site (correction rate, missing-field rate, insurance-capture accuracy, MCO-eligibility catch rate) and review results with intake site leads.Own the intake training curriculum, job aids, and NetSmart intake-workflow configuration; co-deliver intake refreshers with the Front-Desk / Admin working lead.Verify insurance eligibility for every client using payer portals (Availity, NaviNet, UHCprovider, MCO portals), EDI 270/271 transactions, and direct outreach; resolve coordination-of-benefits (COB) exceptions.Lead the weekly insurance review of the active client census — coverage, MCO enrollment, active authorization, units remaining, and rate-setup accuracy. MCO Enrollments & Payer Relations Determine and confirm each client's MCO (Trillium, Partners, Alliance, or other); complete MCO enrollment/registration so the client is active in the MCO's system for authorization.Document MCO, plan, member ID, and effective date in NetSmart; proactively resolve enrollment gaps (member-not-found, between MCOs, incorrect assignments).Serve as day-to-day primary point of contact with MCO and commercial payer representatives; escalate systemic issues to the COO. Provider Contracts & Payer Agreements Own Anuvia's provider-side contracts with MCOs and commercial payers for billable services — in-network agreements, single-case agreements, letters of agreement — from credentialing through renewal.Coordinate credentialing / re-credentialing with each MCO and commercial payer so Anuvia is an eligible billing provider for the services it delivers.Maintain a single contract repository / payer matrix; own the renewal calendar and initiate renewal conversations at least 90 days before expiration.Support MCO and payer rate negotiations by providing utilization data, reimbursement analysis, and denial-trend evidence to the Controller and COO. NetSmart EHR Configuration & Optimization Serve as Anuvia's operational lead for NetSmart EHR configuration, upgrades, and optimizations relevant to the revenue cycle.Stand up Authorization Tracking inside NetSmart as the single source of truth — replacing spreadsheets and paper logs.Configure eligibility / EDI 270/271 workflow, payer records, rate tables, electronic billing, and clearinghouse routing inside NetSmart.Build NetSmart dashboards, alerts, and reports supporting the daily / weekly operating rhythm — intake queue, expiring authorizations, MCO enrollment exceptions, and A/R by root cause.Coordinate user acceptance testing (UAT), validation testing, and go-live readiness for every NetSmart change affecting revenue cycle. Denial Management & Administrative Appeals Maintain the central denial log; categorize every denial by payer, reason, and root cause (administrative vs. clinical).Own the appeal process for administrative denials — timely filing, COB, eligibility, MCO enrollment, missing documentation, rate / setup errors.Route clinical / medical-necessity denials to Clinical with a complete appeal packet.Track appeals to closure; report monthly on overturn rate, denial root causes, and corrective actions. Billing, A/R & Revenue Cycle Partnership Drive the organization to a Client Service → Clean Claim Submitted cycle time of five business days or less (outstanding claims ≤ 3 days).Own A/R follow-up for claims whose root cause is revenue-cycle-attributable (auth, eligibility, MCO enrollment, or rate setup).Review A/R aging monthly with Billing; segment by root cause and assign clear ownership.Reconcile EOBs against client accounts; reconcile NetSmart rate setup against payer contracts; flag and resolve discrepancies. Training, Documentation & Adoption Design, develop, and maintain a standardized training curriculum for all revenue cycle functions.Create role-specific training manuals, workflow documentation, job aids, quick-reference guides, and e-learning modules.Facilitate train-the-trainer sessions with the RCM team; coordinate competency assessments and ongoing education.Ensure training materials remain aligned with payer regulations, organizational policies, and NetSmart enhancements. Process Improvement Lead revenue cycle process improvement initiatives using continuous-improvement methodologies (Lean, Six Sigma, or comparable).Evaluate existing workflows to identify inefficiencies, bottlenecks, and revenue leakage opportunities.Monitor implementation outcomes and present results and recommendations to the Executive Leadership Team. Payer Compliance & Currency Subscribe to and read every MCO and commercial-payer provider bulletin, policy update, fee-schedule revision, and authorization-rule change.Maintain a living payer matrix with each payer's rules, contacts, portals, and most recent update.Update SOPs, NetSmart configuration, and team training within 10 business days of any published payer change — sooner if the change affects active claims.Serve as the single point of contact for MCO and commercial payer audits and post-payment reviews; support CARF preparation and accreditation reviews. Supervisory Responsibilities Directly supervises a team of five at launch, organized into three functional sub-groups: (1) UM Specialists — three seats covering Outpatient services, ACTT / Remote Locations / MCO Enrollments, and Residential Treatment; (2) Insurance & Billing — Insurance Specialist (Private / Commercial) and Biller; (3) Denials & Appeals — a shared work stream where UM Specialists own administrative appeals and the team collectively maintains the denial log and root-cause categorization. Leads a daily huddle, a weekly Billing Meeting with Clinical and RCM, and presents the Core KPI scorecard to the Executive Leadership Team monthly. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Growth Path • This is a founding leadership role. Scope of direct supervision may expand as the Revenue Cycle function matures — including intake operations, additional billing and enrollment seats, and adjacent front-end revenue cycle work — based on demonstrated results and organizational needs. Competencies Adaptability Nurturing Unity Vitality Integrity Accountability Adaptability: Innovate and be creative Nurturing: Demonstrate compassionate care Unity: Support diversity and motivate one another Vitality: Challenge the status quo Integrity: Demand uncompromising ethical standards and inspire trust Accountability: Take ownership of our decisions and take responsibility for their impact Analytical Thinking • Collects and researches data • Designs workflows and procedures • Identifies data relationships and dependencies • Identifies problems in a timely manner and resolves problems in early stages • Synthesizes complex or diverse information • Uses intuition and experience to complement data Consistent Achievement Focus • Demonstrates persistence and overcomes obstacles • Develops project plans, coordinates projects, and delivers on time and on budget • Measures self against standard of excellence • Recognizes and acts on opportunities • Sets and achieves challenging goals • Takes calculated risks to accomplish goals Effective Communication • Communicates changes and progress • Exhibits good listening and comprehension • Expresses ideas and thoughts in written form • Expresses ideas and thoughts verbally • Keeps others adequately informed • Makes self available and provides regular performance feedback • Selects and uses appropriate communication methods Organizational Change Management • Builds commitment and overcomes resistance • Communicates change effectively • Develops strategies to achieve organizational goals • Develops workable implementation plans • Monitors transition and evaluates results • Prepares and supports those affected by change Transformational Leadership • Acts in accordance with vision • Communicates vision and gains commitment • Creates a clear, compelling vision • Develops subordinates' skills and encourages growth • Displays passion and optimism • Mobilizes others to fulfill the vision Qualifications & Requirements Education & Experience Bachelor's degree in healthcare administration, business, health information management, or a related field (or equivalent experience). Five or more years of progressive revenue cycle, Utilization Management, or insurance experience in behavioral health or healthcare. Two or more years of supervisory or working-lead experience directing UM, intake, or billing staff. Certified Revenue Cycle Representative (CRCR) or equivalent revenue cycle certification preferred. Experience configuring EHR workflows required; NetSmart strongly preferred. Language Ability Read, analyze, and interpret payer contracts, regulatory guidance, business, professional, and technical documents. Write clear reports, business correspondence, procedure manuals, and payer-facing communications. Effectively present information and respond to questions from executives, clinical staff, payers, and community partners. Mathematical Ability Compute revenue cycle metrics including unit rates, contractual adjustments, denial rates, cycle times, and A/R aging. Fluent with whole numbers, fractions, decimals, and percentages; advanced spreadsheet formulas and business intelligence tools. Reasoning Ability Apply judgment and structured problem-solving to interpret payer policies, resolve claims and authorization exceptions, and design workflows in ambiguous situations. Interpret a variety of instructions furnished in written, oral, diagram, schedule, or regulatory form. Clerical Ability Knowledge of administrative and clerical procedures — document management, records retention, forms design, correspondence workflows, and healthcare office procedures and terminology. Computer Skills • NetSmart EHR configuration and workflow proficiency (strongly preferred) • Payer portals (Availity, NaviNet, UHCprovider, MCO portals), clearinghouses, and EDI 270/271 • Advanced Microsoft Excel; SQL, Power BI, or Tableau (preferred) • MS Office applications and other software required of the position • General use of personal computers, printers, and copiers Certificates & Licenses • CRCR (Certified Revenue Cycle Representative) preferred • Lean Six Sigma Green or Black Belt (preferred) • Project Management Professional (PMP) (preferred) • Clinical licensure (RN, LPN, LCSW, LPC) — a plus, not required • Valid NC or SC Driver's License required Physical Demands In compliance with the Americans with Disabilities Act of 1990 (ADA), the following outlines the physical, mental, and environmental conditions of the essential duties of this position. Physical On the job, the employee must: • Bend, carry, climb, crawl, crouch or stoop • Handle objects (manual dexterity) • Kneel, push/pull • Reach above shoulder level • Sit, stand, walk • Use fine finger movements Mental On the job, the employee must be able to: • Communicate orally • Apply general intelligence • Listen • Perform calculations • Read and comprehend • Reason and analyze • Write Environmental On the job, the employee: • May be exposed to dust, fumes, or gases • May experience marked changes in temperature and/or humidity • May be around moving equipment • May be exposed to noise typical of a healthcare office setting • May work in shared office space Lift/carry loads: Light (up to 25 lbs.) Why Join Anuvia? — Compensation & Benefits We invest in the people who invest in our clients. Our comprehensive benefits package includes: ❤ Health Benefits: Medical, dental, and vision coverage with low monthly premiums — no waiting period. ⏰ Generous Time Off: Competitive PTO policies to support your work-life balance. ???? Company-Provided Disability Insurance: Short- and long-term coverage included. ???? 401(k) — 7% Employer Contribution: Employer contributes 7% after