Job Description

Position Summary

The Revenue Cycle Manager is responsible for developing, planning, organizing, and implementing strategies to optimize billing, collections, and reimbursement while ensuring compliance with all federal and state regulations. This position oversees day-to-day revenue cycle functions including registration, billing, collections, coding, prior authorization, Health Information Management (HIM), accounts receivable, and financial counseling.

The manager builds and executes proactive strategies to prevent denials before they occur, ensure accurate and timely reimbursement, and position Valor Health for scalable growth. The role drives the use of automation, innovation, and process redesign to improve efficiency and transparency while placing the patient financial experience at the forefront of all activities. The Revenue Cycle Manager serves as a subject matter expert on reimbursement, payer relations, and revenue cycle best practices, and partners across departments to align revenue cycle outcomes with the broader goals of the health system.

Principal Functions and Responsibilities

1. Develop strategic plans and programs for the Revenue Cycle team and ensure goals and objectives are properly defined and clearly established.
2. Provide or ensure the correct technical expertise related to CPT (Current Procedural Terminology) and ICD-10 (International Classification of Diseases) coding, with preparation for ICD-11 adoption.
3. Oversight of the Chargemaster, including maintaining a system to track, revise, and update with the appropriate CPT and ICD-10 codes for accurate and timely charging of services.
4. Develop and utilize quality improvement tools to measure billing accuracy and efficiency. Address areas of concern identified from such efforts and report to the CFO.
5. Provide training for all Valor providers and appropriate staff on changes or updates to coding and billing practices for Critical Access Hospitals.
6. Assure compliance with HIPAA privacy and security standards, the No Surprises Act, the CMS Hospital Price Transparency Rule, Medicare Advantage authorization requirements, and other applicable federal and state billing regulations.
7. Maintain strong relationships with insurance companies; identify and resolve issues that may slow cash flow (denial trends, new insurance plans, new providers, or network changes).
8. Drive net revenue integrity by ensuring accurate charge capture, timely reimbursement, effective patient collections, and proactive bad debt reduction strategies that safeguard the financial health of the organization.
9. Review and evaluate the performance of the team on a regular basis and ensure overall performance remains within pre-established goals and objectives.
10. Serve as the organizational subject matter expert on revenue cycle operations, payer relations, and reimbursement policy, advising leadership on regulatory shifts and payer trends.
11. Lead proactive denial prevention strategies and ensure claims are submitted accurately and timely with first-pass acceptance goals in mind.
12. Partner cross-functionally with Finance, Operations, IT, and clinical leadership to ensure revenue cycle processes are aligned with broader system strategy and patient care priorities.
13. Collaborate with IT and Data teams to implement automation, identify process bottlenecks, and uncover trends in revenue behavior that inform forecasting and strategy.
14. Guide revenue cycle staff through change initiatives, providing mentorship, structure, and clear communication during transitions.
15. Ensure audits are completed in all areas of the Revenue Cycle (registration accuracy, billing, coding, regulatory compliance, payer audits, etc.) and appropriate follow-up and education take place.
16. Regularly report performance to the CFO and other leadership, using dashboards that include but are not limited to:
17. Days in Accounts Receivable (AR) by payer class
18. Clean claim rate and first-pass acceptance rate
19. Denial and avoidable write-off rates
20. Discharged Not Final Billed (DNFB) days
21. Patient pay collections and financial clearance rates
22. Patient financial experience scores tied to billing and collections
23. Actively research revenue cycle best practices, benchmark performance, and implement process improvements that align Valor Health with leading industry standards.
24. Ensure patient-centered financial practices are embedded into the revenue cycle, including:
25. Compliance with price transparency rules and accurate advance cost estimates
26. Patient-friendly billing statements, digital payment options, and financial counseling services
27. Integration of charity care and financial assistance programs into billing workflows
28. Monitoring and improving patient satisfaction with billing and collections
29. Other duties as assigned.

Qualifications

Required Qualifications

1. Bachelors degree in healthcare administration, business, or another related field.
2. 8+ years of progressive experience in healthcare revenue cycle operations, with at least 5 years in a supervisory or management role, demonstrating expertise in billing compliance, coding oversight, payer contracting, and denials management.
3. Minimum of three years leading and managing staff.
4. Competency in Electronic Health Record (EHR) and billing systems, with direct experience in Cerner revenue cycle applications and related payer workflows.
5. Strong analytical skills, adept in interpreting strategic vision into measurable financial and operational outcomes and experienced in leading change.
6. Proven ability to effectively communicate with all levels of staff personnel and leadership.
7. Strong ethics and a high level of personal and professional integrity.
8. BLS certification required within 6 months of employment

Preferred Qualifications and Experience

1. Masters degree in business, healthcare administration, or a related field.
2. One of the following certifications is preferred: RHIA (Registered Health Information Administrator), CRCR (Certified Revenue Cycle Representative), or CHFP (Certified Healthcare Financial Professional).
3. Experience leading optimization projects or implementations in Cerner or comparable revenue cycle platforms.
4. Experience working with Critical Access Hospitals
5. Active membership in HFMA, AHIMA, or a similar professional organization.

Physical Requirements

1. Must be able to lift 25 lbs.
2. Continuous sitting, standing, walking.
3. Normal manual dexterity.
4. Correctable vision and hearing.
5. Must be able to read, write, and speak clearly.

This position is onsite, and relocation is negotiable.

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