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Revenue Cycle Manager
Empowering Wellness, Transforming Lives
Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, Community Support, and American TrueCare, our mission is to provide comprehensive support and care that not only addresses immediate concerns but also fosters long-term well-being.
As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation. We are committed to empowering our members to achieve self-sufficiency in health, creating a ripple effect that strengthens families and communities.
Our work culture at Optima MMG is built on pride, passion, and a collective commitment to making a positive difference in people's lives. Our team members are dedicated problem-solvers who bring their unique skills and perspectives to the table. We believe that by fostering a collaborative and supportive environment, we can unlock the full potential of our team and, in turn, provide the best possible care to our members.
A career at Optima MMG is an opportunity to be part of a dynamic and forward-thinking organization. We encourage continuous learning and professional growth, providing our employees with access to industry experts, cutting-edge technologies, and a supportive community that values each individual's contributions. Join us on this journey to not only advance your career but to be a driving force in transforming lives and communities through passionate and fulfilling work!
Job Summary:
The Revenue Cycle Manager is responsible for overseeing and optimizing all billing and reimbursement functions across Serene Health Group. This role manages both capitated and fee-for-service (FFS) revenue streams, ensuring accurate payment, reconciliation, and financial performance across Medi-Cal and Managed Care contracts.
The Revenue Cycle Manager partners closely with operations, finance, and leadership to identify revenue gaps, resolve discrepancies, and ensure compliant, efficient revenue cycle operations.
Duties/Responsibilities:
- Oversee day-to-day revenue cycle operations, including claims submission, payment posting, denials management, and accounts receivable (AR).
- Ensure timely and accurate billing and reimbursement across Medi-Cal and Managed Care payer contracts.
- Manage and reconcile capitated revenue streams, including member rosters, payment tracking, and variance analysis.
- Oversee fee-for-service billing, including claims accuracy, submission, and reimbursement optimization.
- Identify and resolve discrepancies between expected and actual payments across all payer arrangements.
- Monitor AR performance and ensure timely follow-up on outstanding claims.
- Analyze denial trends and implement corrective actions to improve reimbursement outcomes.
- Ensure compliance with CMS, Medi-Cal, DHCS, and payer-specific billing requirements.
- Support internal and external audits and maintain documentation to minimize recoupment risk.
- Develop and maintain reporting dashboards related to AR, payments, denials, and revenue trends.
- Utilize reporting tools to analyze financial performance and provide actionable insights.
- Partner with operations and leadership to ensure alignment between services rendered and revenue captured.
- Perform other duties as assigned.
Education and Experience:
- Bachelor's degree in Healthcare Administration, Finance, or related field required.
- Minimum of 5 years of revenue cycle management experience.
- Experience with capitated payment models and fee-for-service billing.
- Experience with Medi-Cal and Managed Care billing.
- Experience with clearinghouses such as Waystar.
- Strong proficiency in Excel and reporting/analytics.
Required Skills/Abilities:
- Strong analytical and problem-solving skills.
- Excellent written and verbal communication skills.
- High attention to detail and organizational skills.
- Ability to manage multiple priorities and meet deadlines.
- Ability to interpret payer contracts and reimbursement structures.
- Proficiency in billing systems, clearinghouses, and Microsoft Office (Excel, Word).
- Ability to work in a fast-paced, growth-oriented environment.
Physical Requirements:
- Prolonged periods sitting at a desk and working on a computer.
- Must be able to lift up to 10 pounds at times.
Benefits
Our full-time employees are eligible for the following benefits enrollment after 60 days of employment:
Medical, Dental, & Vision Benefits: We have various insurance options for you and your family.
Short & Long-Term Disability Benefits: Protection when you need it most.
Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans: Added security for you and your loved ones.
Flexible Spending Accounts: Manage your finances with flexibility.
Employee Assistance Program (EAP): Support when life throws challenges your way.
401(K): Building your financial future with us. Effective after 1 year of employment.
Paid Vacation and Sick Leave: Flexibility for the planned and unplanned.
Paid Holidays: Quality time to enjoy celebrations.
Employee Referral Program: Share the opportunities and reap the rewards.
Company Discount Program: Enjoy savings on everyday expenses and memberships.
Equal Employment Opportunity
Optima Medical Management Group and its divisions are an Equal Opportunity Employer. Optima MMG is committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other characteristic protected by federal, state or local laws. Optima MMG is committed to providing reasonable accommodation for individuals with disabilities.
Pre-Employment
Optima Medical Management Group is a drug-free workplace. Employment is contingent upon a successful pre-employment drug screening and background check.
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