Manager, Revenue Cycle Management

Advanced Rx Management•Sunrise, FL

12d•Onsite

About The Position

A results-driven Revenue Cycle Manager will lead day-to-day revenue cycle operations across Workers’ Compensation, Personal Injury, and Pharmacy claims. This role will be responsible for driving collections, reducing aged accounts receivable, improving payer follow-up, managing denials and appeals, and ensuring collectors are working accounts based on the highest opportunity for reimbursement. The Revenue Cycle Manager will directly oversee collector performance and work closely with both onshore and offshore resources. This individual must be comfortable working in a high-volume environment with a significant outstanding AR inventory and must be able to use data to identify problems, prioritize accounts, and drive measurable improvements in cash collections. This is a hands-on management position. The successful candidate will be expected to understand the details behind the numbers, identify barriers to payment, coach the team, and escalate payer or operational issues before they negatively impact cash.

Requirements

5+ years of healthcare revenue cycle, collections, reimbursement, or accounts receivable experience.
2+ years of management or supervisory experience within Revenue Cycle Management.
Demonstrated experience managing high-volume healthcare AR.
Strong knowledge of claim follow-up, denials, appeals, underpayments, and payer reimbursement.
Experience managing and coaching collection teams.
Strong analytical skills with the ability to interpret AR and collection data.
Demonstrated ability to establish KPIs and hold teams accountable for measurable results.
Advanced proficiency with Excel and revenue cycle reporting.
Strong communication within all levels of the organization, problem-solving, and organizational skills.
Strong ownership and accountability
Urgency around cash and AR
Data-driven decision-making
Ability to identify root causes rather than simply report problems
Strong negotiation and escalation skills
Ability to lead through operational change
Effective coaching and performance management
Ability to manage competing priorities
Willingness to work directly in the details when necessary

Nice To Haves

Workers’ Compensation revenue cycle experience strongly preferred.
Pharmacy or prescription claims experience.
Personal Injury/PIP experience.
Experience managing payer-specific collection teams.
Experience managing offshore revenue cycle resources.
Experience with both electronic and paper claim environments.
Experience managing large, aged AR cleanup initiatives.
Knowledge of state-specific Workers’ Compensation billing and reimbursement requirements.
Experience working with third-party administrators, PBMs, Workers’ Compensation carriers, and commercial payers.

Responsibilities

Manage daily revenue cycle and collection activities across Workers’ Compensation, Personal Injury, and Pharmacy accounts.
Drive achievement of weekly and monthly cash collection targets.
Monitor AR by payer, state, client, aging category, balance, claim status, and denial reason.
Develop targeted strategies for high-dollar and aged accounts.
Ensure collectors prioritize accounts based on collectability, reimbursement opportunity, aging, and payer requirements.
Identify accounts requiring corrected claims, resubmissions, reconsiderations, appeals, medical records, authorization documentation, or payer escalation.
Ensure timely and appropriate follow-up on unpaid and underpaid claims.
Monitor claims with no payer response and establish escalation strategies to determine claim status and secure reimbursement.
Partner with leadership on initiatives to improve electronic claim submission and reduce reliance on untracked manual processes.
Establish daily, weekly, and monthly collection expectations for the team.
Monitor actual collections against established cash targets.
Identify trends contributing to cash shortfalls and develop corrective action plans.
Reduce aging, particularly accounts greater than 90, 120, and 180 days.
Identify high-value AR opportunities and ensure resources are appropriately assigned.
Evaluate expected reimbursement versus billed charges and actual payments to identify underpayments.
Monitor unresolved payer balances and ensure timely escalation.
Provide accurate cash forecasts and AR risk assessments to the Vice President of Revenue Cycle.
Develop payer-specific collection strategies based on claim volume, outstanding AR, reimbursement trends, and payment behavior.
Identify systemic payer issues impacting reimbursement.
Track payer denials, underpayments, no-response claims, and recurring processing issues.
Coordinate payer escalations when standard collection activity is unsuccessful.
Work with internal leadership and external payer contacts to resolve significant outstanding balances.
Maintain knowledge of Workers’ Compensation payer requirements, timely filing requirements, documentation requirements, fee schedules, and appeal processes.
Identify reimbursement trends requiring contractual, legal, regulatory, or executive escalation.
Provide direct leadership and accountability for Revenue Cycle collectors and support staff.
Manage both onshore and offshore collection resources.
Establish clear productivity and quality expectations.
Conduct regular team meetings and individual performance reviews.
Review collector work queues and ensure accounts are being worked according to established priorities.
Coach employees on payer strategy, claim research, appeals, documentation, and effective collection techniques.
Recognize top performers and develop employees with growth potential.
Identify persistent performance deficiencies and implement documented performance improvement plans when necessary.
Ensure staffing and workload distribution align with AR volume and collection opportunities.
Evaluate current Capture workflows and identify opportunities to eliminate unnecessary manual work, delays, and duplicate effort.
Standardize onboarding and EMR access processes.
Develop SOPs and training materials for Capture Report management and EMR access.
Implement workflow improvements designed to increase productivity and reduce escalations.
Partner with Revenue Cycle, Operations, IT, and clinic teams to improve communication and service delivery.
Develop appropriate escalation pathways so issues are resolved at the correct level without unnecessary leadership involvement.