revenue cycle manager

Central Coast Orthopedics

<p><b>About Central Coast Orthopedic Medical Group </b></p><p>Central Coast Orthopedic Medical Group is a leading orthopedic practice serving the Central Coast. Our skilled physicians and staff deliver exceptional care and advanced treatments in a collaborative and supportive environment that values professionalism and growth.</p><p><b>Position Summary </b></p><p>The Revenue Cycle Manager (RCM) oversees all financial processes related to patient revenue for a busy orthopedic medical group. This role ensures timely and accurate billing, coding, claims processing, reimbursement, and collections. The RCM is responsible for optimizing revenue cycle operations, improving cash flow, ensuring regulatory compliance, and collaborating with clinical and administrative teams to support a seamless patient financial experience.</p><p><b>Key Responsibilities </b></p><p>Revenue Cycle Oversight</p><ul><li>Manage all end-to-end revenue cycle functions, including patient registration, insurance verification, coding, charge entry, billing, payment posting, A/R management, and collections.</li><li>Develop, implement, and monitor processes that improve clean claim rates and reduce denials.</li><li>Analyze financial performance metrics such as days in A/R, denial rates, collection rates, and net revenue recovery.</li></ul><p>Coding &amp; Compliance</p><ul><li>Ensure accurate orthopedic coding (ICD-10, CPT, HCPCS) and documentation in alignment with payer policies and regulatory requirements.</li><li>Partner with providers to ensure complete and compliant clinical documentation.</li><li>Oversee internal audits to reduce risk and optimize reimbursement.</li></ul><p>Staff Leadership</p><ul><li>Lead, train, and mentor revenue cycle staff, including billing specialists, coders, and front-office team members.</li><li>Set clear performance metrics and conduct regular performance evaluations.</li><li>Create a collaborative environment focused on accuracy, accountability, and continuous improvement.</li></ul><p>Payer &amp; Financial Management</p><ul><li>Serve as primary liaison with insurance carriers to resolve complex billing issues and negotiate reimbursement when appropriate.</li><li>Monitor payer policy changes specific to orthopedics (e.g., prior authorizations, surgical bundling, implants).</li><li>Work with leadership to develop financial forecasts, revenue projections, and budget planning.</li><li>Act as a Liason for patients with billing questions</li></ul><p>Operational Improvement</p><ul><li>Identify workflow bottlenecks and implement process enhancements using KPIs and data-driven decision-making.</li><li>Lead initiatives to improve patient collections, including transparent billing practices and payment plan programs.</li><li>Ensure the practice&rsquo;s EHR and practice management systems are optimized for orthopedic workflows.</li></ul><p>Regulatory &amp; Policy Compliance</p><ul><li>Maintain compliance with HIPAA, CMS, and commercial payer regulations.</li><li>Ensure adherence to orthopedic-specific billing rules, including global surgical periods and procedure-specific billing guidelines.</li></ul><p><b>Qualifications </b></p><p><b>Required</b></p><ul><li>Bachelor&rsquo;s degree in Healthcare Administration, Business, Finance, or related field (or equivalent experience).</li><li>3&ndash;5+ years of revenue cycle management experience in a specialty or multi-specialty medical group.</li><li>Strong knowledge of orthopedic billing and coding guidelines.</li><li>Proven leadership experience.</li><li>Proficiency with EHR and practice management systems (ModMed, Epic, Athenahealth, NextGen, eClinicalWorks, or similar).</li></ul><p><b>Preferred</b></p><ul><li>Certified Professional Coder (CPC), Certified Professional Biller (CPB), or similar certification.</li><li>Experience with value-based care programs and orthopedic-specific reimbursement models.</li><li>Familiarity with workers&rsquo; compensation and personal injury billing processes.</li></ul><p><b>Work Environment </b></p><ul><li>Office-based with standard business hours, fully on-site</li><li>Occasional travel to clinics</li><li>Join a team that values collaboration, integrity, and excellence in patient care. Apply today to make a meaningful impact at Central Coast Orthopedic Medical Group</li></ul><p>Job Type: Full-time</p><p>Pay: $80,000.00 - $120,000.00 per year</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Vision insurance</li></ul><p>Experience:</p><ul><li>Revenue Cycle Management: 3 years (Required)</li></ul><p>Work Location: In person</p>

Revenue Cycle Manager

Columbia Dental Health Center

<p><b>Revenue Cycle Manager (Dental)</b></p><p><b>About Us</b></p><p>Omni Dental, LLC operates multiple dental offices focused on delivering high-quality patient care while maintaining strong financial performance. We&rsquo;re scaling, and we need someone who can tighten up our revenue cycle, not just maintain it.</p><p><b>Position Summary</b></p><p>We&rsquo;re hiring a <b>Revenue Cycle Manager</b> to take control of billing, collections, and insurance processes across all locations. This role is responsible for eliminating inefficiencies, reducing AR, and making sure money doesn&rsquo;t sit uncollected.</p><p>If you&rsquo;ve managed dental revenue cycles before, you already know where things go wrong&mdash;this role expects you to fix it.</p><p><b>Key Responsibilities</b></p><ul><li>Oversee the <b>full dental revenue cycle</b> across all offices</li><li>Manage insurance verification, treatment plan estimates, claim submission, and collections</li><li>Monitor and improve KPIs:</li><li>Accounts Receivable (AR) days</li><li>Insurance aging (30/60/90+)</li><li>Case acceptance vs. collections</li><li>Claim denial rates</li><li>Identify and fix breakdowns in front desk &rarr; clinical &rarr; billing handoffs</li><li>Ensure accurate coding (CDT codes), documentation, and compliance</li><li>Lead and train front office and billing teams across locations</li><li>Standardize processes across offices (no more &ldquo;every location does it differently&rdquo;)</li><li>Handle complex insurance issues, appeals, and payer follow-up</li><li>Work with management to forecast revenue and improve cash flow</li><li>Optimize PMS/EHR systems (Dentrix, Eaglesoft, Open Dental, etc.)</li></ul><p><b>Qualifications</b></p><ul><li>5+ years of <b>dental revenue cycle or dental billing management experience</b></li><li>Strong knowledge of:</li><li>PPO insurance workflows</li><li>CDT coding</li><li>Treatment planning and insurance breakdowns</li><li>Experience managing multi-location or group practices</li><li>Proven ability to reduce AR and increase collections</li><li>Strong leadership&mdash;able to hold staff accountable and improve performance</li><li>Highly organized and data-driven</li></ul><p><b>Preferred Qualifications</b></p><ul><li>Experience with Dentrix, Eaglesoft, Open Dental, or similar systems</li><li>Background in dental office management or regional operations</li><li>Certification in dental billing/coding (preferred but not required)</li></ul><p><b>What We Offer</b></p><ul><li>Competitive salary</li><li>Health, dental, and vision benefits</li><li>PTO and paid holidays</li><li>Opportunity to grow with a multi-office organization</li></ul><p>If you are this person, please send in your resume!</p><p>Pay: From $60,000.00 per year</p><p>Benefits:</p><ul><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Vision insurance</li></ul><p>Work Location: In person</p>

TriasMD

<div><p>TriasMD is seeking a Director of Revenue Cycle Management (RCM) to lead and optimize the end-to-end revenue cycle across its growing network of ambulatory surgery centers (ASCs) and affiliated physician practices.</p><p>
This role will serve as the internal owner of revenue cycle performance, responsible for overseeing outsourced RCM vendors, partnering with operations and clinical leadership, and implementing data-driven processes to improve collections performance, reduce denials, and accelerate cash flow.</p><p>
The Director will play a critical role in building a scalable revenue cycle infrastructure for a private equity-backed, multi-site healthcare platform experiencing rapid growth.</p><p>
This role reports to the Chief Financial Officer.</p><p><b>
Key Responsibilities</b></p><p><b>
Revenue Cycle Strategy &amp; Performance</b></p><ul><li>
Own the end-to-end revenue cycle, including front-end intake, coding, billing, collections, and denial management.</li><li>
Establish and manage RCM performance dashboards tracking key metrics including:<ul><li>
Net collection rate</li><li>
Denial rate</li><li>
AR days</li><li>
AR aging</li><li>
Charge lag</li><li>
First-pass claim acceptance</li></ul></li><li>
Develop and execute initiatives to improve collections performance and reduce revenue leakage.</li></ul><p><b>
Vendor Management &amp; Accountability</b></p><ul><li>
Serve as the primary internal owner of outsourced RCM vendor performance.</li><li>
Manage billing vendors and ensure compliance with service level agreements (SLAs).</li><li>
Conduct regular vendor performance reviews focused on:<ul><li>
denial trends</li><li>
collections performance</li><li>
turnaround times</li><li>
payer follow-up effectiveness</li></ul></li><li>
Partner with vendors to identify and resolve operational issues impacting claims and reimbursement.</li></ul><p><b>
Denial Management &amp; Root Cause Analysis</b></p><ul><li>
Lead denial analytics to identify root causes across the revenue cycle.</li><li>
Distinguish between preventable operational denials and payer-related issues.</li><li>
Implement structured processes to reduce high-volume denial categories, including:<ul><li>
authorization failures</li><li>
eligibility verification issues</li><li>
coding errors</li><li>
claim submission errors.</li></ul></li></ul><p><b>
Front-End Revenue Cycle Optimization</b></p><p>
Partner closely with operations to strengthen front-end processes, including:</p><ul><li>
insurance eligibility verification</li><li>
prior authorization workflows</li><li>
patient financial counseling</li><li>
point-of-service collections.</li></ul><p>
Implement systems and workflows that reduce first-pass denials and billing errors.</p><p><b>
Aged Accounts Receivable Recovery</b></p><ul><li>
Lead targeted initiatives to reduce aged accounts receivable.</li><li>
Oversee recovery strategies for &gt;90-day AR balances.</li><li>
Identify opportunities to recover collectible legacy AR and improve follow-up workflows.</li></ul><p><b>
Process Improvement &amp; Automation</b></p><p>
Identify and implement improvements in revenue cycle operations, including:</p><ul><li>
automation of eligibility verification</li><li>
clearinghouse claim edits and scrubbing controls</li><li>
automation of authorization tracking</li><li>
improved documentation and coding workflows.</li></ul><p>
Evaluate emerging technology solutions and automation tools to improve efficiency.</p><p><b>
Cross-Functional Collaboration</b></p><p>
Serve as the bridge between:</p><ul><li>
Operations</li><li>
Clinical teams</li><li>
Finance</li><li>
RCM vendors</li></ul><p>
Ensure operational workflows support efficient revenue cycle performance and reduce preventable denials.</p><p><b>
Key Performance Metrics</b></p><p>
The Director of RCM will be accountable for improving the following metrics:</p><ul><li>
Net Collection Rate (target: <b>97%+</b>)</li><li>
Denial Rate (target: <b>&lt; 5% initially, trending toward &lt; 2%</b>)</li><li>
Net AR Days (target: <b>&lt; 40 days</b>)</li><li>
AR &gt;90 days (target: <b>&lt; 25%</b>)</li><li>
Charge lag (target: <b>&lt; 3 days</b>)</li></ul><p>
</p><p><b>Qualifications</b></p><p><b>
Required</b></p><ul><li>
8+ years of experience in healthcare revenue cycle management</li><li>
3+ years in ASC, surgical specialty, or physician practice RCM</li><li>
Experience managing outsourced RCM vendors</li><li>
Deep understanding of:<ul><li>
ASC billing</li><li>
payer contracting and reimbursement</li><li>
denial management</li><li>
coding and charge capture workflows</li></ul></li></ul><p><b>
Preferred</b></p><ul><li>
Experience in private equity-backed healthcare platforms</li><li>
Experience scaling revenue cycle operations across multi-site organizations</li><li>
Strong data and analytics capability (Power BI, Tableau, or similar tools)</li></ul><p><b>
Leadership &amp; Skills</b></p><p>
The ideal candidate will demonstrate:</p><ul><li>
Strong operational leadership</li><li>
Ability to manage cross-functional teams</li><li>
Deep analytical capability</li><li>
Strong communication skills to work with physicians, operators, and finance leaders</li></ul><p>
The candidate must be able to translate revenue cycle data into actionable operational improvements.</p><p><b>
Impact of Role</b></p><p>
This role will directly impact:</p><ul><li>
cash flow</li><li>
working capital</li><li>
EBITDA performance</li><li>
payer reimbursement integrity</li></ul><p>
and will be a key contributor to TriasMD&rsquo;s continued growth and operational scalability.</p><p><b>
Compensation</b></p><p>
Competitive base salary plus performance-based bonus aligned with revenue cycle performance improvements.</p></div><p></p>

NIVA Health

<div><p><b>Revenue Cycle Manager, Advanced Wound Care (Remote)</b></p><p>
Location: Remote<br>
Compensation: $75,000 base salary + Bonus Incentive Program</p><p></p><p><b>
About NIVA Health</b></p><p>
NIVA Health is one of the nation&rsquo;s leading advanced wound care providers, delivering high quality, patient-centered care directly to patients where they are. Since 2015, we have helped thousands of patients achieve improved healing outcomes through innovative, non-invasive, and regenerative care models.</p><p>
Our mission is to provide a world-class patient and employee experience, and we are committed to building a culture rooted in our core values: Teamwork. Resilience. Open-mindedness. Ownership. Positivity. (TROOP)</p><p><b>
Position Overview</b></p><p>
Are you ready to build something meaningful and make a measurable impact?</p><p>
NIVA Health is seeking a strategic, hands-on Revenue Cycle Manager who can do more than oversee billing operations. This leader will build systems, develop people, improve performance, and help create the infrastructure needed to support national growth.</p><p>
This role is critical to optimizing revenue cycle operations as NIVA Health continues to scale. The ideal candidate brings strong expertise in healthcare billing, Medicare reimbursement, payer processes, and operational leadership, while also aligning with our culture and commitment to excellence.</p><p>
This is an opportunity for someone who thrives in a fast-paced, growth-oriented environment and wants to play a meaningful role in shaping the future of a nationally expanding healthcare organization.</p><p><b>
Key Responsibilities</b></p><ul><li>
Oversee and optimize the full revenue cycle, including charge capture, coding, billing, accounts receivable follow-up, and collections</li><li>
Ensure timely and accurate claim submission, with a focus on Medicare and commercial payers</li><li>
Monitor and improve key revenue cycle performance metrics, including AR days, denial rates, and net collection rate</li><li>
Lead denial management strategy, including root cause analysis, corrective action planning, and process improvement</li><li>
Develop, train, and manage internal team members and/or external billing partners</li><li>
Build scalable workflows and systems to support rapid organizational growth</li><li>
Collaborate cross-functionally with clinical and operations teams to improve alignment, efficiency, and financial outcomes</li><li>
Maintain compliance with all federal, state, and payer requirements</li></ul><p><b>
Additional Roles and Responsibilities</b></p><ul><li>
Oversee insurance verification and benefits verification processes to ensure accurate coverage determination before services are rendered</li><li>
Manage prior authorizations efficiently and accurately to support seamless patient care and optimize reimbursement</li><li>
Coordinate and facilitate single case agreements with payers when applicable</li><li>
Monitor and manage PCP referrals to ensure all required approvals and supporting documentation are secured</li><li>
Partner with clinical, front office, and billing teams to minimize denials, prevent delays, and strengthen overall revenue cycle performance</li><li>
Collaborate with Records, Clinical, and Operations teams to ensure timely documentation completion, record accessibility, and claim readiness</li></ul><p><b>
Key Performance Indicators (KPIs)</b></p><p>
Success in this role will be measured by the ability to improve performance, reduce delays, and build a scalable, high-performing revenue cycle function. Key performance indicators include:</p><ul><li>
Clean Claim Rate: 98% or higher</li><li>
Claim Submission Timeliness: Claims submitted within 48 hours of encounter or claim-ready documentation</li><li>
Denial Rate: 3% or less</li><li>
Denial Resolution Turnaround: Average of 5 business days or less</li><li>
Claims Paid Without Rework: 95% or higher</li><li>
Net Collection Rate: 95% or higher</li><li>
AR Days: Quarter-over-quarter reduction and ongoing optimization</li><li>
Hold Buckets: Maintained at no more than 25 days behind</li><li>
Verification / VOB Accuracy: 98% or higher</li><li>
Prior Authorization and PCP Referral Timeliness: 95% or more completed within required timelines</li><li>
Documentation Issue Escalation: Identified and communicated within 1 business day</li><li>
Monthly Reporting: Delivered accurately and on time</li><li>
Revenue Cycle Improvement: Ongoing implementation of workflow improvements that reduce denials, delays, and revenue leakage</li></ul><p><b>
What We&rsquo;re Looking For</b></p><ul><li>
5+ years of healthcare revenue cycle experience, preferably in wound care, specialty care, or a similarly complex reimbursement environment</li><li>
Strong knowledge of Medicare Part B billing, coding, reimbursement, and compliance</li><li>
Proven ability to improve revenue cycle performance metrics and operational outcomes</li><li>
Experience leading teams and/or managing third-party billing vendors</li><li>
Strong analytical and problem-solving skills, with the ability to identify trends and drive corrective action</li><li>
Comfortable working in a fast-paced, high-growth environment</li><li>
Strong communication skills and the ability to collaborate effectively across departments</li><li>
A builder&rsquo;s mindset, with a willingness to improve systems, create structure, and drive accountability</li></ul><p><b>
How This Role Lives Our Core Values (TROOP)</b></p><ul><li>
Teamwork: Collaborate across departments and support a unified approach to patient care, operational excellence, and revenue cycle success.</li><li>
Resilience: Navigate complex billing challenges, denials, and evolving payer requirements with persistence, adaptability, and determination.</li><li>
Open-mindedness: Embrace new ideas, technologies, and process improvements that enhance efficiency, scalability, and performance.</li><li>
Ownership: Take full accountability for revenue cycle outcomes, performance metrics, team development, and continuous improvement.</li><li>
Positivity: Lead with energy, professionalism, and optimism while fostering a motivated, solutions-oriented team environment.</li></ul><p><b>
Leadership and Strategic Impact</b></p><ul><li>
Build and implement scalable revenue cycle systems to support national growth</li><li>
Identify inefficiencies and drive continuous process improvement across people, systems, and workflows</li><li>
Serve as a trusted partner to leadership by contributing to financial strategy and operational performance</li><li>
Develop a high-performing, accountable team culture focused on excellence and measurable results</li></ul><p><b>
Expected Outcomes</b></p><ul><li>
Improved cash flow through faster and more accurate billing</li><li>
Reduced denials and increased collections</li><li>
Stronger revenue cycle team performance and accountability</li><li>
Scalable systems and workflows that support continued expansion</li><li>
Enhanced compliance and reduced financial risk</li></ul><p><b>
Why This Role Matters</b></p><p>
As NIVA Health continues to grow as a national leader in mobile advanced wound care, the Revenue Cycle Manager will play a pivotal role in ensuring financial strength, operational excellence, and scalability.</p><p>
This is an opportunity to build, lead, and make a lasting impact, not only on operations, but also on the patients and communities we serve.</p><p><b>
Compensation and Benefits</b></p><ul><li>
Base Salary: $75,000</li><li>
Bonus Incentive Program: Performance-based</li><li>
Health, dental, and vision benefits</li><li>
Paid time off</li><li>
Remote work flexibility</li><li>
Opportunity for growth within a rapidly scaling organization</li></ul><p><b>
Join Us</b></p><p>
If you are a driven leader who thrives on building systems, developing people, and delivering results, learn more about us at https://nivahealthwoundcare.com/ and become part of NIVA Health&rsquo;s mission to <i>redefine patient care&mdash;one healing wound at a time.
</i></p><p></p><p>#IND-NWC</p></div>

Backpack Healthcare

<div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><h2 class="jobSectionHeader"><b>Sr. Revenue Cycle Manager</b></h2>
<p><b>
Location:</b> Remote<br>
<b>Department:</b> Finance<br>
<b>Reports to:</b> VP Finance</p>
<p><b>
Compensation: </b>$80,000/year</p>
<p></p>
<h3 class="jobSectionHeader"><b>Build the Revenue Engine Behind Mission-Driven Care</b></h3>
<p>
Backpack Medical Group is seeking an experienced <b>Sr. Revenue Cycle Manager</b> to lead and operationalize our end-to-end revenue cycle across a multi-state behavioral health organization.</p>
<p>
This is a high-impact leadership role responsible for stabilizing, strengthening, and scaling billing operations that support care delivery to underserved Medicaid populations.</p>
<p>
You will directly manage a team of 3&ndash;4 billing specialists and take full ownership of billing operations &mdash; from patient intake through claim resolution, posting, and collections.</p>
<p><b>
Mandatory Requirement:</b> Advanced experience with eClinicalWorks (ECW)<br>
<b>Strongly Preferred:</b> Behavioral health and Medicaid experience &amp; Lean Six Sigma Certification</p>
<p></p>
<h2 class="jobSectionHeader"><b>What You'll Accomplish in the First 60 Days</b></h2>
<p>
You'll immediately focus on stabilizing and strengthening our revenue cycle infrastructure by:</p>
<ul>
<li><p>Stabilizing urgent revenue cycle gaps</p>
</li>
<li><p>Building foundational reporting infrastructure</p>
</li>
<li><p>Correcting system mappings and configuration issues</p>
</li>
<li><p>Implementing controls to eliminate:</p>
<ul>
<li><p>Aged claims</p>
</li>
<li><p>Posting errors</p>
</li>
<li><p>Patient and payer balance backlogs</p>
</li>
</ul></li></ul><p>This role is both strategic and hands-on &mdash; ideal for someone who thrives on fixing broken processes and building scalable systems.</p>
<p></p>
<h2 class="jobSectionHeader"><b>Ideal Candidate Profile</b></h2>
<p>
We're looking for a leader who is:</p>
<ul>
<li><p>A systems thinker who can stabilize complex workflows</p>
</li>
<li><p>Hands-on (not purely strategic)</p>
</li>
<li><p>Comfortable repairing inefficient or broken processes</p>
</li>
<li><p>Data-driven and audit-oriented</p>
</li>
<li><p>Highly organized and detail-obsessed</p>
</li>
<li><p>A strong communicator across finance, clinical, and technical teams</p>
</li>
</ul><p></p><h2 class="jobSectionHeader"><b>Purpose of the Role</b></h2>
<p>
This performance agreement outlines expectations and success metrics for the Sr. Revenue Cycle Manager/ Director at Backpack Medical Group.</p>
<p>
This role is critical to:</p>
<ul>
<li><p>Strengthening billing infrastructure</p>
</li>
<li><p>Improving collections performance</p>
</li>
<li><p>Accelerating cash flow</p>
</li>
<li><p>Standardizing revenue cycle operations</p>
</li>
<li><p>Supporting scalable behavioral health services for underserved Medicaid populations</p>
</li>
</ul><p>You will be accountable for end-to-end revenue cycle performance, team leadership, process standardization, and cash acceleration &mdash; directly aligning billing performance with organizational growth and mission delivery.</p>
<p></p>
<h1 class="jobSectionHeader"><b>Scope of Responsibilities</b></h1>
<h2 class="jobSectionHeader"><b>Revenue Cycle Oversight</b></h2>
<p>
Provide operational ownership across the full billing lifecycle, including:</p>
<ul>
<li><p>Eligibility and prior authorization verification</p>
</li>
<li><p>Claim creation, transfer, and submission through <b>eClinicalWorks (ECW)</b></p>
</li>
<li><p>Payment posting, reconciliation, and deposit tracking</p>
</li>
<li><p>Patient balance follow-up and payer balance resolution</p>
</li>
<li><p>Denial management and aged accounts recovery</p>
</li>
</ul><p>Ensure billing compliance across:</p>
<ul>
<li><p>Credentialing status</p>
</li>
<li><p>Supervision requirements</p>
</li>
<li><p>CPT / ICD / POS combinations</p>
</li>
<li><p>Fee schedule mapping</p>
</li>
<li><p>Payer contract terms</p>
</li>
</ul><p></p><h2 class="jobSectionHeader"><b>Team Leadership &amp; Operational Management</b></h2>
<ul>
<li><p>Directly supervise and lead 3&ndash;4 billing specialists</p>
</li>
<li><p>Maintain productivity standards, quality audits, and KPI accountability</p>
</li>
<li><p>Develop and document SOPs and internal controls</p>
</li>
<li><p>Manage billing ticket prioritization to ensure timely responses to internal and external inquiries</p>
</li>
</ul><p></p><h2 class="jobSectionHeader"><b>Immediate Infrastructure &amp; Stabilization (First 60 Days) ️</b></h2>
<p>
Lead development and operationalization of key infrastructure:</p>
<ul>
<li><p>Validate payer data across systems</p>
</li>
<li><p>Identify and correct posting errors</p>
</li>
<li><p>Lead team through existing Claim Denial Projects</p>
</li>
<li><p>Establish payer portal access across all payers</p>
</li>
<li><p>Conduct internal systems review and adjust settings:</p>
<ul>
<li><p>Validate and correct supervision mappings</p>
</li>
<li><p>Confirm POS, payer ID, and fee schedule crosswalk accuracy</p>
</li>
<li><p>Resolve over-applied postings</p>
</li>
</ul></li></ul><p></p><h2 class="jobSectionHeader"><b>Claims Management &amp; Compliance ✅</b></h2>
<ul>
<li><p>Ensure timely claim submission</p>
</li>
<li><p>Validate coding combinations and billing readiness criteria</p>
</li>
<li><p>Track denials with documented root-cause analysis</p>
</li>
<li><p>Coordinate corrective actions across departments to prevent recurrence</p>
</li>
</ul><p></p><h2 class="jobSectionHeader"><b>Payment Posting &amp; Reconciliation Oversight</b></h2>
<ul>
<li><p>Cross-check bank deposits and patient payments for posting accuracy</p>
</li>
</ul><p></p><h2 class="jobSectionHeader"><b>Patient &amp; Payer Balance Resolution</b></h2>
<ul>
<li><p>Monitor patient statement generation and notification workflows</p>
</li>
<li><p>Coordinate balance resolution and write-off processes consistent with policy</p>
</li>
</ul><p></p><h2 class="jobSectionHeader"><b>Credentialing &amp; Provider Lifecycle Alignment</b></h2>
<ul>
<li><p>Partner with Credentialing, HR, and Clinical leadership to confirm provider readiness prior to billing</p>
</li>
<li><p>Track supervision changes and effective dates</p>
</li>
</ul><p></p><h2 class="jobSectionHeader"><b>Reporting, Analytics &amp; Strategic Initiatives</b></h2>
<ul>
<li><p>Monitor A/R aging, denial trends, posting lag, and clean claim performance</p>
</li>
<li><p>Lead targeted initiatives to reduce aged payer and patient balances</p>
</li>
<li><p>Participate in strategic billing initiatives including reimbursement testing and workflow optimization</p>
</li>
</ul><p></p><h1 class="jobSectionHeader"><b>Qualifications</b></h1>
<h2 class="jobSectionHeader"><b>Soft Skills</b></h2>
<ul>
<li><p>Investigative mindset with strong root-cause problem-solving ability</p>
</li>
<li><p>Proven leadership capability with direct team management</p>
</li>
<li><p>Excellent cross-functional communication and stakeholder alignment</p>
</li>
<li><p>Results-oriented and data-driven decision maker</p>
</li>
<li><p>Mission-aligned with improving access to care for underserved populations ❤️</p>
</li>
<li><p>Long-term partnership orientation and commitment to organizational growth</p>
</li>
</ul><p></p><h2 class="jobSectionHeader"><b>Hard Skills</b></h2>
<ul>
<li><p>Advanced <b>eClinicalWorks (ECW)</b> billing experience (mandatory)</p>
</li>
<li><p>MS Excel reporting proficiency (mandatory)</p>
</li>
<li><p>Payment posting expertise</p>
</li>
<li><p>Denial management and A/R recovery experience</p>
</li>
<li><p>Familiarity with Waystar, Availity, payer portals, and payment platforms</p>
</li>
<li><p>Strong CPT / ICD / POS validation knowledge</p>
</li>
<li><p>5+ years of healthcare revenue cycle leadership experience with direct reports</p>
</li>
<li><p>Behavioral health billing and Medicaid experience (preferred)</p>
</li>
</ul><p></p><h3 class="jobSectionHeader"><b>Why This Role Matters</b></h3>
<p>
This is more than a billing leadership role &mdash; it's an opportunity to build operational excellence that directly expands access to behavioral health services.</p>
<p>
If you're a hands-on revenue cycle leader who thrives in complexity and wants to create scalable systems that support mission-driven care, we'd love to hear from you.</p></div></div><br>
</div>
</div></div></div></div></div></div></div></div></div></div></div></div></div><div></div><p><b>Backpack Health is an Equal Opportunity Employer. We believe that the strength of our care depends on the diversity and wellbeing of our team. We celebrate differences in age, color, disability, ethnicity, gender identity or expression, national origin, physical and mental ability, race, religion, sexual orientation, veteran status, and other traits that make each person unique. We welcome and encourage diverse candidates to apply for any position for which they are qualified and to bring their unique perspectives, experiences, and talents to our team.</b></p>
<p><b>
Backpack Health is an Equal Opportunity Employer. We believe that the strength of our care depends on the diversity and wellbeing of our team. We celebrate differences in age, color, disability, ethnicity, gender identity or expression, national origin, physical and mental ability, race, religion, sexual orientation, veteran status, and other traits that make each person unique. We welcome and encourage diverse candidates to apply for any position for which they are qualified and to bring their unique perspectives, experiences, and talents to our team.</b></p></div>

Sr. Revenue Cycle Manager

Planned Parenthood

<div><div><div><b>About Us</b></div>
<div>Planned Parenthood League of Massachusetts (PPLM) is the state&rsquo;s leading provider of sexual and reproductive health care, nationally recognized for education and research. Our mission: ensure everyone in Massachusetts has access to compassionate, judgment-free care and education. We operate four health centers and offer telehealth statewide as part of a network of 600 Planned Parenthood affiliates nationwide.</div></div><div><br>
</div><div>
<div><h2 class="jobSectionHeader"><b>About the Role</b></h2>
<p>
Planned Parenthood League of Massachusetts (PPLM) is seeking an experienced <b>Revenue Cycle Manager (RCM)</b> to oversee all aspects of the organization&rsquo;s revenue cycle operations. This role serves as the primary liaison with PPLM&rsquo;s revenue cycle partners&mdash;including the Clinical Health Network for Transformation (CHN) RCM team and BetterHealth&mdash;and plays a key part in ensuring efficient billing, collections, reimbursement processes, and financial sustainability.</p>
<p>
The ideal candidate is a strategic thinker with deep knowledge of medical billing, coding, and revenue cycle management, and excels at collaboration, problem-solving, and process improvement.</p>
</div>
</div><h3 class="jobSectionHeader"><b>Your Day to Day:</b></h3><div>
<div><h3 class="jobSectionHeader"><b>Revenue Cycle Oversight &amp; Collaboration</b></h3>
<ul><li>Serve as the primary point of contact between PPLM, CHN Revenue Cycle Team, and BetterHealth.</li>
<li>Monitor revenue cycle functions and key performance indicators (KPIs), identify best practices, and communicate organizational needs.</li>
<li>Lead financial analysis and reimbursement planning for new services and strategic initiatives.</li>
<li>Maintain effective relationships with payer representatives to support contract performance and appropriate reimbursement.</li>
</ul><h3 class="jobSectionHeader"><b>Financial Reporting &amp; Analysis</b></h3>
<ul><li>Report regularly on accounts receivable, KPIs, and trends to the CFO and Health Center leadership.</li>
<li>Support the accounting team with revenue reporting, reimbursement tracking, and contractual reserve analysis.</li>
<li>Provide insights and recommendations to improve financial performance and operational efficiency.</li>
</ul><h3 class="jobSectionHeader"><b>Process Improvement &amp; Compliance</b></h3>
<ul><li>Manage pricing, reimbursement, contract review, and EHR system configuration to optimize workflow and efficiency.</li>
<li>Partner with health center staff to resolve billing issues and implement improvements.</li>
<li>Document procedures and create standardized workflows.</li>
<li>Monitor billing processes for specific programs including AB Funding, At Home STI Testing, and Telehealth Medication Abortion.</li>
<li>Support compliance activities, including annual coding audits and quarterly audits related to MassHealth certification requirements.</li>
<li>Stay informed on changes in medical billing standards, regulations, and payer policies.</li>
</ul><h3 class="jobSectionHeader"><b>Cross‑Team Engagement</b></h3>
<ul><li>Engage regularly with health center teams to review KPIs, identify process barriers, and share best practices.</li>
<li>Help staff connect operational practices with the organization&rsquo;s revenue goals and financial sustainability.</li>
<li>Support organizational productivity initiatives and complete additional tasks as assigned.</li>
</ul></div></div><h3 class="jobSectionHeader"><b>Qualifications:</b></h3><ul>
<li>BA/BS degree <b>or</b> equivalent relevant work experience required.</li>
<li>8&ndash;10 years of experience in revenue cycle operations.</li>
<li>Experience with Epic, AthenaNet, or comparable EHR systems.</li>
<li>Proficiency with Microsoft Office 365 (Teams, SharePoint, Excel).</li>
<li>Advanced knowledge of medical terminology, procedures, and billing practices.</li>
<li>Strong understanding of HCPCS, CPT, and ICD‑9/ICD‑10 coding standards and collection regulations.</li>
<li>Knowledge of state and federal billing requirements (including Title X) preferred.</li>
<li>Strong analytical skills with comfort interpreting financial data.</li>
<li>Excellent verbal communication, decision-making ability, and organizational skills.</li>
<li>Commitment to maintaining patient confidentiality in accordance with HIPAA.</li>
</ul><div>Based on a 37.5 hour work week.</div><div>
<div><b>Why Join Us?</b></div>
<div></div>
<div>We offer a comprehensive and competitive benefits package, including:</div>
<div></div>
<ul><li>Generous Paid Time Off</li></ul>
<ul><li>Medical, Dental, and Vision Insurance</li></ul>
<ul><li>403(b) Retirement Plan with employer match</li></ul>
<ul><li>Life and Disability Insurance</li></ul>
<ul><li>Professional Development Opportunities</li></ul>
<ul><li>Commuter Benefits</li></ul>
<ul><li>A mission-driven workplace that values equity, inclusion, and belonging</li></ul>
<div></div>
<div>PPLM is a 501(c)(3) charitable organization, and an equal opportunity employer that values a diverse workforce and a culture of inclusivity and belonging. Equity, diversity, and inclusion are core values at PPLM and a chance for us to make long-term, meaningful change. We are actively working to build a culture that reflects the communities we serve and embodies cultural humility, recognizing that advancing health equity begins within our own organization. We are taking steps to make progress in our own organization and are committed to building an equity practice in all aspects of our work.
</div>
<div></div><div>We believe that communities most impacted by health inequities must be centered in the work we do. Therefore, we strongly encourage applications from Black, Latinx, Asian, and Indigenous people of color, Trans and gender non-conforming people, LGBTQIA+ people, people with disabilities, and working-class people for all our positions.
</div>
<div></div><div>Employment and advancement at PPLM are based on individual qualifications and abilities, without regard to race, color, religion, gender, sexual orientation, age, national origin, disability, veteran status, or any other protected characteristic under law.</div></div></div>

Confidential

<div>
 <p>
  We are seeking a healthcare professional with a strong medical background to support Fraud, Waste &amp; Abuse (FWA) detection, clinical audit, and Revenue Cycle Management (RCM) activities. The role focuses on identifying billing irregularities, ensuring clinical and coding compliance, optimizing reimbursement, and reducing financial leakage while maintaining regulatory and ethical standards.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Key Responsibilities
  </strong>
 </p>
 <p>
  <br/>
 </p>
 <p>
  Fraud, Waste &amp; Abuse (FWA)
 </p>
 <p>
  <br/>
 </p>
 <ul>
  <li>
   Identify, investigate, and analyze potential fraud, waste, and abuse related to medical billing, coding, and clinical documentation
  </li>
  <li>
   Conduct pre-payment and post-payment reviews of claims to detect inappropriate utilization or billing patterns
  </li>
  <li>
   Collaborate with internal teams and external stakeholders to resolve FWA cases and recommend corrective actions
  </li>
  <li>
   Prepare detailed FWA investigation reports, findings, and root cause analysis
  </li>
  <li>
   Support implementation of FWA prevention controls and compliance initiatives
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  Audit &amp; Compliance
 </p>
 <p>
  <br/>
 </p>
 <ul>
  <li>
   Perform clinical and coding audits (IP, OP, ER, Daycare, Pharmacy, Procedures)
  </li>
  <li>
   Validate compliance with payer contracts, medical necessity guidelines, and regulatory standards
  </li>
  <li>
   Review medical records to ensure accuracy of ICD-10, CPT, HCPCS, DRG, and modifier usage
  </li>
  <li>
   Identify documentation gaps and recommend improvements to providers and coding teams
  </li>
  <li>
   Support internal, external, and regulatory audits
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  Revenue Cycle Management (RCM)
 </p>
 <p>
  <br/>
 </p>
 <ul>
  <li>
   Review end-to-end RCM processes, including charge capture, coding, billing, and reimbursement
  </li>
  <li>
   Analyze denials, underpayments, and revenue leakage trends
  </li>
  <li>
   Work closely with billing and coding teams to optimize reimbursement and reduce denials
  </li>
  <li>
   Support payer negotiations and contract compliance reviews
  </li>
  <li>
   Ensure adherence to turnaround times, accuracy benchmarks, and KPIs
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Required Qualifications
  </strong>
 </p>
 <p>
  <br/>
 </p>
 <p>
  Education
 </p>
 <ul>
  <li>
   Medical background required, such as:
  </li>
  <li>
   MBBS / MD / BDS / BAMS / BHMS
  </li>
  <li>
   B.Sc. Nursing / Allied Health Sciences
  </li>
  <li>
   Additional certification in Medical Coding, Auditing, or Compliance is preferred
  </li>
 </ul>
 <p>
  Experience
 </p>
 <ul>
  <li>
   3&ndash;8+ years of experience in FWA, Medical Audit, or RCM
  </li>
  <li>
   Strong exposure to health insurance, TPA, hospital, or payer environment
  </li>
  <li>
   Hands-on experience reviewing medical records and claims
  </li>
 </ul>
 <p>
  Skills &amp; Competencies
 </p>
 <ul>
  <li>
   Strong knowledge of clinical workflows, medical necessity, and treatment protocols
  </li>
  <li>
   Proficiency in ICD-10, CPT, HCPCS, DRG, and payer guidelines
  </li>
  <li>
   Analytical skills with the ability to detect abnormal billing patterns
  </li>
  <li>
   Excellent documentation, reporting, and communication skills
  </li>
  <li>
   High ethical standards and attention to detail
  </li>
 </ul>
 <p>
  Preferred Certifications (Optional)
 </p>
 <ul>
  <li>
   Certified Professional Medical Auditor (CPMA)
  </li>
  <li>
   Certified Professional Coder (CPC / CCS)
  </li>
  <li>
   Certified in Healthcare Compliance (CHC)
  </li>
  <li>
   CFE (Certified Fraud Examiner) &ndash; advantage
  </li>
 </ul>
 <p>
  Key Attributes
 </p>
 <ul>
  <li>
   Strong clinical judgment
  </li>
  <li>
   Investigative mindset
  </li>
  <li>
   Detail-oriented and compliance-focused
  </li>
  <li>
   Ability to work independently and cross-functionally
  </li>
 </ul>
 <p>
 </p>
</div>


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