Revenue Cycle Optimization Manager

1. Revenue Analysis & Optimization

• Analyze AR trends, reimbursement patterns, and payer behaviors to identify revenue opportunities and gaps.
• Develop and implement strategies to enhance revenue integrity and maximize collections.
• Oversee charge capture audits and provide recommendations to improve provider documentation and coding accuracy.
• Identify underpayments and missed billing opportunities across all payer types.

2. Denial Management & Appeals Strategy

• Evaluate denial data to identify root causes and work with the RCM Manager to implement corrective action plans.
• Track denial trends by payer and lead efforts to reduce preventable write-offs.
• Guide the appeals process by ensuring timely follow-up and strong supporting documentation.
• Ensure billing practices remain current with evolving payer policies and regulatory requirements.

3. Revenue Cycle Strategy & Payer Collaboration

• Serve as a subject matter expert on payer reimbursement strategies and revenue cycle performance metrics.
• Collaborate with the COO and RCM Manager to align revenue cycle strategy with organizational priorities.
• Lead payer performance reviews and identify opportunities to renegotiate contracts or escalate chronic reimbursement issues.
• Provide insight on evolving reimbursement models, fee schedules, and payer initiatives impacting collections.

4. Process Improvement & System Optimization

• Recommend and implement process improvements to increase workflow efficiency and reduce revenue leakage.
• Collaborate with the RCM Manager to optimize the use of EHR and billing platforms (e.g., Modernizing Medicine).
• Lead revenue cycle reporting enhancements to improve visibility into key performance indicators (KPIs).
• Evaluate tools and technologies to support automation of charge capture, claims processing, and denials tracking.

5. Team Collaboration & Education

• Partner with the RCM Manager to align priorities and ensure consistent communication with the billing team.
• Co-develop training programs for staff focused on denial prevention, compliance, and payer documentation requirements.
• Facilitate cross-functional meetings to review revenue cycle performance, bottlenecks, and improvement initiatives.
• Establish KPIs that integrate front-end and back-end revenue cycle metrics with broader organizational goals.

Education & Certification:

• Bachelor’s degree in Healthcare Administration, Business, or related field required.
• Certification in Revenue Cycle Management (e.g., CRCR, CMPE, HFMA) preferred.

Experience:

• Minimum of 5 years of experience in revenue cycle management or healthcare reimbursement, preferably within a multi-provider clinical setting.
• Demonstrated success in denial management, payer negotiation, and charge capture optimization.
• Deep understanding of payer policies, coding requirements, and revenue cycle best practices.
• Experience working with EHR and practice management systems (Modernizing Medicine highly preferred).

Skills & Competencies:

• Strong analytical skills and the ability to interpret complex data to drive financial improvement.
• Knowledge of commercial and government payer billing, coding, and compliance requirements.
• Proactive problem-solver with the ability to lead initiatives and influence outcomes across departments.
• Skilled communicator with the ability to collaborate with clinical, operational, and billing stakeholders.
• Detail-oriented with strong organizational and project management skills.

Other Requirements: 

• Ability to adapt in a dynamic healthcare environment and stay current with industry regulations and payer changes. 
• Passion for identifying opportunities for revenue optimization and operational efficiency. 
• Commitment to maintaining confidentiality and compliance with healthcare laws and accounting standards. 

Schedule Requirements:

• Travel up to 0%

Physical Requirements:

• Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
• Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards
• Must be able to lift and carry up to 10 lbs
• Prolonged periods of sitting, standing and bending