Qureos Mentor

Centrum Health

<div><div>WHO WE ARE

NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

NeueHealth delivers clinical care to health consumers through our owned clinics &ndash; Centrum Health and Premier Medical &ndash; as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.</div>
The Manager of Revenue Cycle Management oversees revenue cycle operations across Centrum's medical centers, including Ponsol and Neighborhood Health, ensuring accurate reimbursement, regulatory compliance, and financial integrity across Medicare Advantage, ACA/Exchange, and Medicaid lines of business. This role is responsible for the back-end revenue cycle, including claims adjudication, denial management, appeals, payment posting, accounts receivable, and reimbursement reconciliation.

The Manager develops and oversees revenue cycle processes to ensure timely claim resolution, accurate payment posting, effective accounts receivable management, and compliance with CMS, state Medicaid, HIPAA, and payer-specific requirements. The role also manages the fee-for-service (FFS) billing vendor, monitors performance against established standards, and implements controls to ensure claims and payments are accurately processed and reconciled.

Working in partnership with Finance, Operations, Medical Coding, and Medical Auditing, the Manager drives revenue integrity initiatives, supports clean-claim performance, improves reimbursement outcomes, oversees revenue cycle education for clinic leadership, and ensures effective collection of copays and point-of-service balances. This position also resolves complex payer and patient billing issues and performs other duties as assigned in support of departmental and organizational financial performance
<div>
SCOPE OF WORK
</div>
This position carries revenue cycle responsibility across all Centrum centers (including Ponsol and Neighborhood Health), with primary ownership of the post-submission cycle, and is expected to operate cross-functionally and flexibly as organizational needs evolve. The scope of the role includes, but is not limited to, the following:
<ul>
<li>Monitor and manage the revenue cycle once claims leave the door &mdash; tracking rejections, denials, appeals, and payment posting through to resolution.</li>
<li>Manage, monitor, and reconcile the fee-for-service (FFS) billing vendor to ensure submissions, payments, and performance meet contractual and internal expectations.</li>
<li>Monitor and improve charge capture processes in partnership with Coding, Operations, and Clinical leadership.</li>
<li>Implement and maintain a proactive management system to ensure payments are posted accurately and on time and that no claim goes unworked.</li>
<li>Oversee revenue-cycle training for the medical centers and ensure processes are correct, consistent, and compliant.</li>
<li>Work closely with Finance and center managers to ensure copays and point-of-service balances are collected.</li>
<li>Safeguard revenue integrity &mdash; ensuring charges, codes, and claims are complete, accurate, and compliant across all centers.</li>
<li>Assume additional tasks, projects, and responsibilities as needed to support leadership and enterprise priorities.</li></ul><div> 

ESSENTIAL JOB FUNCTIONS
</div>
The following responsibilities are representative of the work performed in this role. Other duties may be assigned as organizational needs and regulatory requirements evolve.

Revenue Cycle Operations &amp; Oversight
<ul>
<li>Direct revenue cycle operations with primary ownership of the post-submission cycle: claim rejections, denials, appeals, payment posting, and accounts receivable.</li>
<li>Monitor claims from submission through adjudication and payment, resolving rejections and denials promptly to minimize revenue leakage.</li>
<li>Oversee accounts receivable, ensuring timely collection, follow-up, and resolution of outstanding balances and billing disputes.</li>
<li>Develop, implement, and maintain revenue-cycle policies and procedures to ensure accuracy, consistency, and efficiency.</li>
<li>Establish, monitor, and improve revenue cycle performance metrics including denial rates, clean claim rates, accounts receivable aging, reimbursement accuracy, and cash collections.</li>
</ul>
Denials, Rejections &amp; Payment Posting
<ul>
<li>Analyze rejection and denial trends, identify root causes, and implement corrective actions and prevention strategies.</li>
<li>Ensure accurate and timely posting of payments, adjustments, and remittances (ERA/EOB), maintaining a proactive monitoring system so no payment is missed.</li>
<li>Reconcile expected versus actual reimbursement and resolve variances.</li>
<li>Develop and implement denial prevention strategies by identifying root causes and partnering with operational stakeholders to improve first-pass claim acceptance.</li>
</ul>
FFS Vendor Management &amp; Reconciliation
<ul>
<li>Manage and monitor the fee-for-service (FFS) billing vendor, including performance, service levels, and issue resolution.</li>
<li>Conduct regular reconciliation of vendor submissions and payments against internal records and contractual expectations.</li>
<li>Hold the vendor accountable to agreed KPIs, turnaround standards, and reporting requirements.</li>
</ul>
Compliance &amp; Revenue Integrity
<ul>
<li>Ensure revenue-cycle processes are consistent, correct, and compliant with CMS, state Medicaid, HIPAA, and payer-specific guidelines.</li>
<li>Safeguard revenue integrity across all centers and lines of business, ensuring charges, codes, and claims are complete and accurate.</li>
<li>Stay informed of industry trends and regulatory/payer updates, implementing necessary changes promptly.</li>
<li>Perform and coordinate regular reviews and audits of billing records to ensure accuracy and compliance.</li>
</ul>
Collections &amp; Center Partnership
<ul>
<li>Partner with Finance and center managers to ensure copays and point-of-service balances are consistently collected at the centers.</li>
<li>Align front-desk and back-office workflows across centers with revenue-cycle best practices.</li>
</ul>
Training &amp; Team Leadership
<ul>
<li>Oversee and deliver revenue-cycle training for the medical centers, maintaining high standards and up-to-date knowledge.</li>
<li>Supervise and manage the revenue-cycle / billing team, including hiring, training, coaching, and performance evaluations.</li>
<li>Foster a culture of accountability, service excellence, and continuous improvement.</li>
</ul>
Cross-Functional Collaboration
<ul>
<li>Collaborate with Finance, Operations, Patient Services, and center leadership to streamline workflows and improve communication.</li>
<li>Partner with the Manager of Medical Coding and the Manager of Medical Auditing to align coding accuracy with clean-claim submission and reimbursement integrity.</li>
<li>Manage vendor relationships, including clearinghouses and billing-software providers, to ensure effective service delivery.</li>
</ul>
Reporting &amp; Analytics
<ul>
<li>Prepare and present regular reports on billing activity, accounts receivable, denials, and financial performance to senior leadership.</li>
<li>Build and maintain trackers, dashboards, and executive-facing presentations in Microsoft Excel (pivot tables, formulas, large-dataset analysis) and Microsoft PowerPoint.</li>
<li>Use data analytics to identify trends, quantify financial impact, and drive process improvement.</li>
</ul>
Proactivity &amp; Other Duties
<ul>
<li>Anticipate and adapt to changes in payer policy, regulation, and reimbursement models, proactively adjusting processes and procedures.</li>
<li>Address and resolve escalated billing issues and complex payer or patient disputes.</li>
<li>Assume additional responsibilities and cross-functional tasks as needed, and perform other duties as assigned by the Director of Coding &amp; Billing.</li></ul><div> 

QUALIFICATIONS
</div>
To perform this job successfully, an individual must meet the following qualifications. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Certifications &amp; Licensure

Required
<ul>
<li>Certified Revenue Cycle Representative (CRCR)</li>
<li>Equivalent revenue cycle experience may substitute for certification</li>
<li>Active certification must be maintained in good standing through AAPC, AHIMA, HFMA, or an equivalent credentialing body, including required continuing education units (CEUs).</li>
</ul>
Preferred
<ul>
<li>Certified Professional Coder (CPC)</li>
<li>Certified Risk Adjustment Coder (CRC)</li>
<li>Certified Professional Medical Auditor (CPMA)</li>
<li>Certified Documentation Expert Outpatient (CDEO)</li>
</ul>
Education &amp; Experience
<ul>
<li>Minimum of five (5) years' experience in billing or revenue cycle management, with at least two (2) years in a supervisory role.</li>
<li>Bachelor's degree preferred; equivalent combination of education and experience considered.</li>
<li>Strong knowledge of billing software and electronic health record (EHR) systems.</li>
<li>Familiarity with CMS guidelines and payer-specific billing requirements.</li>
<li>Experience with Medicare Advantage, ACA/Exchange, and Medicaid revenue cycle preferred; FFS billing and vendor-management experience strongly preferred.</li>
</ul>
Knowledge
<ul>
<li>Strong knowledge of the full revenue cycle &mdash; charge capture, claim submission, rejections/denials, payment posting, accounts receivable, and reconciliation.</li>
<li>Working knowledge of ICD-10-CM, CPT, and HCPCS as they relate to clean claims and revenue integrity.</li>
<li>Familiarity with clearinghouses, ERA/remittance processing, and practice-management / billing systems.</li>
</ul>
Language Skills
<ul>
<li>Bilingual proficiency in English and Spanish preferred.</li>
<li>Strong written and verbal communication skills, with the ability to interpret and explain procedural documents and policies effectively.</li>
</ul>
Mathematical Skills
<ul>
<li>Proficiency in calculating percentages, adjustments, and account balances accurately.</li>
<li>Ability to analyze financial data to reconcile discrepancies and identify areas for improvement.</li>
</ul>
Reasoning Ability
<ul>
<li>Strong problem-solving skills and the ability to apply sound judgment to standardized and complex situations.</li>
<li>Capable of making decisions that positively impact team performance and organizational goals.</li>
</ul>
Other Skills &amp; Abilities
<ul>
<li>Advanced proficiency in Microsoft Excel (pivot tables, formulas, and data analysis) and Microsoft PowerPoint (executive-level presentations), with strong working proficiency in Word and Outlook.</li>
<li>Experience with practice-management and billing software.</li>
<li>Strong time-management skills with the ability to manage multiple priorities effectively.</li>
<li>Demonstrates professionalism, initiative, and a commitment to continuous improvement.</li>
<li>Ability to work effectively in a culturally and professionally diverse environment.</li>
<li>Maintains up-to-date knowledge of federal, state, and local compliance standards.</li>
</ul><div><div>As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.</div></div></div>

Manager, Revenue Cycle Management

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Manager, Revenue Cycle Management