Revenue Cycle Manager

Position Summary

The Revenue Cycle Manager is responsible for the leadership, oversight, performance, and continuous improvement of Pacific Health Group's Revenue Cycle operations. This position oversees the full revenue cycle, including billing, coding, claims submission, payment posting, accounts receivable, collections, denials, appeals, payer reconciliation, reimbursement analysis, and revenue reporting.

Essential Duties and Responsibilities

• Lead the day-to-day operations and overall performance of the Revenue Cycle function.
• Oversee billing, coding, claims submission, payment posting, accounts receivable, collections, denials, appeals, and reimbursement activities.
• Establish and maintain effective workflows, internal controls, performance standards, and accountability measures.
• Ensure claims and encounters are submitted accurately and within applicable payer and timely-filing requirements.
• Monitor outstanding, rejected, denied, unpaid, and underpaid claims through resolution.
• Identify revenue leakage, reimbursement delays, and operational barriers affecting revenue.
• Proactively develop and implement corrective action plans when Revenue Cycle performance falls below expectations.
• Ensure accurate billing and coding in accordance with applicable ICD-10, CPT, HCPCS, modifiers, payer requirements, contractual requirements, and organizational standards.
• Maintain direct oversight of accounts receivable and collection activities.
• Oversee the denial and rejection management process from initial identification through final resolution.
• Serve as a primary Revenue Cycle contact for health plans, insurance companies, and other payers regarding billing and reimbursement matters.
• Conduct routine audits of billing, coding, claims, payment posting, collections, adjustments, and other Revenue Cycle activities.
• Develop and maintain Revenue Cycle reports, dashboards, and performance analyses.
• Provide direct supervision, leadership, coaching, and support to assigned Revenue Cycle staff.
• Develop, maintain, and enforce Revenue Cycle policies, procedures, workflows, and standard operating procedures.

Minimum Qualifications

• Minimum of five (5) years of progressive experience in healthcare revenue cycle management, medical billing, reimbursement, coding, healthcare finance, or a related field.
• Previous supervisory or management experience within Revenue Cycle operations.
• Demonstrated experience managing billing, claims, accounts receivable, collections, denials, appeals, and reimbursement processes.
• Strong working knowledge of ICD-10, CPT, HCPCS, modifiers, and healthcare billing practices.
• Strong understanding of managed care reimbursement, payer requirements, claims adjudication, and payer contract administration.
• Knowledge of healthcare billing compliance requirements, HIPAA, and protection of PHI.
• Proficiency with healthcare billing platforms, EHR systems, reporting tools, and Microsoft Office Suite, particularly Excel.
• Strong analytical skills with demonstrated ability to identify trends, conduct root-cause analysis, and implement corrective actions.
• Demonstrated ability to lead teams, establish accountability, manage performance, and oversee complex workflows.
• Excellent written and verbal communication skills.
• Strong organizational skills, attention to detail, independent judgment, and ability to manage competing priorities and deadlines.

Preferred Qualifications

• Bachelor's degree in Healthcare Administration, Finance, Accounting, Business Administration, or a related field; equivalent relevant experience may be considered.
• Certified Professional Coder (CPC), Certified Revenue Cycle Representative (CRCR), Certified Revenue Cycle Professional (CRCP), or related credential.
• Experience with Medi-Cal and California managed care organizations.
• Experience supporting CalAIM Enhanced Care Management (ECM), Community Supports, Community Health Worker programs, Behavioral Health, or similar community-based healthcare services.
• Experience managing multiple payer relationships and reimbursement methodologies.
• Experience implementing or optimizing healthcare billing systems and automated Revenue Cycle workflows.
• Experience working within a rapidly growing healthcare organization.