Manager, Front End Revenue Cycle

Virta Health

4d•$93,000 - $107,000•Remote

About The Position

The Front End Revenue Cycle Manager is responsible for the accuracy, completeness, and timeliness of all upstream revenue cycle activities at Virta Health. This role owns the critical entry points of the revenue cycle — member eligibility, claims entry, and provider credentialing — which directly determine whether a billable claim can be submitted and collected. The Front End Manager ensures that every member who receives a Virta Health service has a verified, complete record in the billing system before a claim is generated, and that all providers and programs are credentialed and enrolled with payers in a timely manner.

Requirements

5+ years of revenue cycle management experience with a focus on front-end functions — eligibility, claims entry, and/or credentialing
Strong working knowledge of ANSI X12 EDI transactions including 270/271 (eligibility), 837 (claims), and 835 (remittance)
Experience with Athena Health or comparable practice management/claims system
Demonstrated ability to manage cross-functional relationships with Client Success, Engineering, and clinical teams
Experience in healthcare technology, digital health, or value-based care environments preferred
Demonstrates a proactive use of AI tools to improve individual output and efficiency

Nice To Haves

Values-driven culture

Responsibilities

Own the end-to-end member eligibility process — from receipt of client eligibility files through verification of active insurance coverage in Athena Health
Define and enforce client eligibility file completeness standards; establish intake SLA with Client Success for incomplete or missing demographic and insurance data
Implement and manage real-time eligibility (RTE) verification (using ANSI X12 270/271) transactions to confirm active coverage before claims are submitted
Develop and maintain a reconciliation process to ensure all active members in Zuora have corresponding verified records in Athena
Identify and resolve eligibility discrepancies, retroactive terminations, and coverage changes before they result in denied claims or revenue loss
Monitor eligibility-related denial trends and implement upstream controls to reduce recurrence
Oversee the accuracy and completeness of claims preparation and entry across all Virta Health products — Diabetes Reversal, Diabetes Management, and Sustainable Weight Loss
Ensure all claims are coded correctly and submitted within payer-specific timely filing windows
Monitor claim submission lag — the time between billing period close and claim submission — and establish benchmarks to reduce exposure
Work with Engineering to improve the flow of billing trigger data from Spark into Athena, reducing manual intervention in claims entry
Implement pre-submission claim scrubbing processes to improve clean claim rates and reduce first-pass rejections
Maintain working knowledge of CPT, HCPCS, and ICD-10 coding requirements relevant to Virta Health's digital health and value-based care model
Manage provider and program credentialing and payer enrollment for all applicable Virta Health providers, locations, and product lines
Ensure all providers are enrolled with payers prior to service delivery to prevent claim denials related to credentialing status
Maintain a credentialing tracking system with defined renewal timelines, expiration alerts, and re-credentialing workflows
Coordinate with Legal, HR, and Clinical Operations on provider onboarding and payer network participation requirements
Recruit, onboard, and develop front-end RCM staff including eligibility specialists, claims entry staff, and credentialing coordinators
Establish role-specific SOPs, training programs, and performance expectations for all front-end positions
Conduct regular performance reviews and provide coaching to develop staff competency in eligibility verification, coding, and claims entry
Partner with the Manager/Director of Operational Effectiveness on reporting and process improvement initiatives affecting front-end functions