Manager, Revenue Cycle - Cash Application & Payment Integrity

Cardinal Health

9d•$89,000 - $114,480

About The Position

Revenue Cycle Management (RCM) is responsible for managing the financial lifecycle of patient accounts and ensuring timely and accurate payment for services provided. This job family is focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue in a manner that is compliant with payer rules and requirements. The revenue cycle shadows the entire patient care journey and begins with patient intake and ends when the patient’s account balance is zero. This team also encompasses a payer administration function that ensures we are successfully operationalizing payer rules and requirements as well as facilitating payer relations and escalation efforts. The Manager, Revenue Cycle – Cash Applications & Payment Integrity will lead cash application, deposit reconciliation, credit balance, and refund operations across the NewCo DME and Pharmacy businesses. This role is responsible for ensuring payments and remittances are accurately received, routed, reconciled, posted, and resolved across a complex environment of multiple businesses, systems, banking relationships, clearinghouses, and payer payment methodologies. This leader will play a critical role in designing scalable processes and controls for an increasingly complex multi-system payment environment.

Requirements

5+ years of hands-on experience in healthcare Revenue Cycle, with a specific focus on leading the entire Cash Applications function preferred.
Bachelor's degree in related field, or equivalent work experience, preferred.
Comprehensive understanding of the payment lifecycle, including EFT/deposit and 835 receipt, EDI routing/splitting, reconciliation, posting, credits, refunds, and final financial control.
Deep Revenue Cycle expertise, an automation-first mindset, and the ability to independently identify issues and drive solutions with minimal oversight.
Strong expertise in 835 ERA/EFT transactions, EDI remittance workflows, payment/remittance splitting, and deposit-to-post reconciliation.
Demonstrated aptitude in EDI/remittance splitting and complex deposit reconciliation.
Proficiency in managing credit balances and refund processes within a healthcare environment.
Experience with system conversions relevant to revenue cycle operations.
A track record of implementing or leveraging automation to enhance revenue cycle efficiency.

Responsibilities

Lead Cash Applications across DME and Pharmacy businesses, ensuring timely and accurate posting and reconciliation.
Own end-to-end deposit reconciliation across bank deposits, EFTs, lockboxes, clearinghouses, remittance files, and Revenue Cycle platforms.
Establish controls to ensure cash is accounted for from deposit/EFT through 835 receipt and final system posting.
Identify and resolve missing, duplicate, misrouted, unapplied, or unreconciled payments.
Standardize reconciliation processes, controls, SLAs, and reporting across businesses.
Serve as the RCM operational SME for 835 ERA/EFT workflows, including receipt, routing, posting, and reconciliation.
Understand and oversee EDI/remittance splitter functionality used to route 835 transactions across multiple businesses and systems.
Partner with IT, clearinghouses, vendors, Treasury, and Finance to resolve missing or unmatched payments and remittances.
Establish monitoring for failed files, splitter exceptions, unmatched EFTs, missing 835s, and reconciliation breaks.
Understand complex transactions including PLBs, recoupments, reversals, offsets, takebacks, and $0 remits.
Lead Cash Applications requirements and workflow design through Revenue Cycle system implementations, integrations, testing, cutover, and stabilization.
Design scalable future-state processes for remittance routing, posting, reconciliation, and exception management.
Drive increased ERA/EFT adoption, auto-posting, automated reconciliation, and straight-through processing.
Proactively identify opportunities to simplify and automate manual processes.
Oversee credit balance identification, validation, and resolution.
Ensure appropriate handling of payer and patient refunds, recoupments, overpayments, and unapplied cash.
Establish controls to prevent duplicate refunds, posting errors, and inappropriate adjustments.
Partner with Finance and Compliance on financial controls and audit requirements.
Lead and develop Cash Applications teams across multiple businesses.
Establish productivity, quality, reconciliation, and performance standards.
Develop KPIs around posting timeliness, reconciliation, unapplied cash, exceptions, credits, and refunds.
Proactively identify operational risks and drive issues through resolution.
Partner effectively across Revenue Cycle, Finance, Treasury, IT, Pharmacy, and other functions.