Revenue Cycle Claims Manager

St. Charles Health System • Remote Oregon, OR

5d • $85,904 - $128,856 • Remote

About The Position

The Claims Manager at St. Charles Health System is responsible for leading the daily operations of the claims function, including billing and insurance follow-up, to optimize reimbursement and support organizational revenue cycle goals. This role oversees claims operations, drives denial prevention and resolution efforts, analyzes claims performance, and implements process improvements that enhance efficiency, compliance, and financial outcomes. The Claims Manager collaborates with clinical, operational, and revenue cycle leaders to resolve complex claims issues, ensure adherence to billing regulations and payer requirements, and promote best practices across the organization. The position provides leadership, coaching, and development for claims supervisors and caregivers while fostering a culture of accountability, continuous improvement, and exceptional service. This position directly supervises other caregivers.

Requirements

• Bachelor's degree in related field. A combination of education and relevant prior experience may be substituted in lieu of a degree.
• Five years of applicable revenue cycle and/or patient financial services experience.
• Two years of experience in a finance field may substitute for two years’ experience.
• One year of leadership experience.
• Ability to travel to business functions/trainings/meetings and all SCHS worksites required.
• Advanced knowledge of healthcare industry, billing and collection practices, revenue cycle processes and payer reimbursement methodologies.
• Strong communication skills, including public speaking and technical writing.
• Demonstrated research and problem-solving skills.
• Ability to operate and make decisions independently.
• Process improvement experience/skills.
• Intermediate skills in Microsoft Office applications: Excel, One Note, Outlook, Teams, Power Point, and Word.
• Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.
• Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level.
• Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation.
• Occasionally (25%): Bending, climbing stairs, reaching overhead, carrying/pushing or pulling 1-10 pounds, grasping/squeezing.
• Rarely (10%): Stooping/kneeling/crouching, lifting, carrying, pushing or pulling 11-25 pounds, operation of a motor vehicle.
• Never (0%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 25-50 pounds, ability to hear whispered speech level.
• Never (0%): Heat, cold, wet/slippery area, noise, dust, vibration, chemical solution, uneven surface.

Nice To Haves

• Applicable revenue cycle certification including coding, compliance, and billing.
• Epic and vendor management experience.

Responsibilities

• Manages the overall operations of claims teams.
• Develops and maintains department policies and procedures.
• Manages the creation and maintenance of training manuals, guides, and standard work.
• Attends and/or leads applicable meetings including huddles, staff meetings, payer meetings, clinical and support department meetings, and educational opportunities as appropriate.
• Maintains strong working knowledge of billing regulations, coding guidelines, reimbursement methodologies, and industry best practices.
• Identifies denial trends in coordination with claim teams and other leader through the completion of audits, claim reviews, data analysis, research, and education.
• Monitors revenue cycle metrics and implements solutions to meet metrics including education, IT optimization, and collaborations with departments, payers, and vendors. Solutions may include writing decision papers, SBAR’s, or presenting content to applicable stakeholders.
• Point person for claim level escalations. Solutions to escalations may include writing decision papers, SBAR’s, or presenting content to applicable stakeholders.
• Supports SCHS Single Billing Office (SBO) senior director as needed.
• Supports Senior Director in budget development, regular monitoring, accountability and meeting all operational targets for all areas within span of control.
• Manages human resource tasks including interviewing, hiring, timekeeping, coaching, mentoring, and performance management.
• Hires, directs, coaches, and monitors the performance of all direct reports, to develop and maintain a high-performance team that meets organizational and department goals.
• Monitors and ensures all direct reports are current with compliance and safety requirements. Implements and manages all organizational safety directives and goals.
• Provides and oversees team’s delivery of customer service in a manner that promotes goodwill, is timely, efficient, and accurate.
• Collaborates with teams to review processes and identify/implement opportunities for improvements, applying Lean principles, concepts, and tools.
• Supports the vision, mission, and values of the organization in all respects.
• Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.
• Delivers customer service in a manner that promotes goodwill and teamwork; timely, efficient, and accurate.
• Collaborates with teams to review processes and identify/implement opportunities for improvements, applying Value Improvement Practice concepts and tools.
• Provides and maintains a safe environment for caregivers, patients, and guests.
• Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies, and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.
• May perform additional duties of similar complexity within the organization, as required or assigned.

Benefits

• Competitive Salary
• Comprehensive benefits including Medical, Dental, Vision for you and your immediate family
• 403b with up to 6% match on Retirement Contributions
• Generous Earned Time Off
• Growth Opportunities within Healthcare

What This Job Offers

• Job Type: Full-time
• Career Level: Manager