Revenue Cycle Management

Advantage Healthcare Services•Huntington Beach, CA

22h•Hybrid

About The Position

Advantage is redefining what it means to be a pharmacy for people with serious behavioral health conditions. We specialize in serving patients with schizophrenia, bipolar disorder, substance use disorder, and related challenges—patients who are often overlooked by traditional healthcare systems. We provide advanced pharmacy services and wraparound care that ensure patients can access and stay on complex medications. We offer in-home and community-based injection support, help patients navigate insurance and prior authorizations, and work closely with providers to overcome barriers to treatment. By strengthening connections between patients, care teams, and support systems, we make it possible for people living with behavioral health challenges to achieve stability and long-term success. In the Revenue Cycle Management Manager role, you will work under the supervision of the Director of Patient Access and Behavioral Health Services. You will lead and oversee the company’s centralized Prior Authorization team and Medical Billing team, ensuring that both functions operate efficiently, accurately, and in full compliance with payer and regulatory requirements. You will be responsible for the end-to-end revenue cycle performance of these teams – from initial authorization through claim submission, reimbursement, and denial resolution – while building processes that reduce turnaround times and maximize approval and collection rates. You will also assist in developing training programs for staff, identifying opportunities for automation and workflow improvement, and partnering with clinical and operations leaders to resolve complex payer or billing issues affecting patient access to care. Success in this role will be demonstrated by measurable improvements in prior authorization turnaround time, first-pass claim acceptance rates, denial reduction, and staff productivity – along with a well-trained, engaged team capable of scaling with the organization’s growth.

Requirements

Strong understanding of payer coverage, prior authorization, and reimbursement processes
Proven ability to lead, motivate, and develop a team in a fast-paced, metrics-driven environment
Excellent analytical skills, with the ability to interpret revenue cycle data and translate it into actionable process improvements
Strong knowledge of medical billing and coding practices, payer requirements, and denial management strategies
Excellent verbal and written communication skills, with the ability to interface confidently with payers, providers, and internal leadership
Proficiency with revenue cycle management, clearinghouse, and authorization tracking software
Strong organizational and project management skills, with the ability to manage multiple priorities and deadlines
Sound judgement and problem-solving skills when handling escalated or complex reimbursement issues

Nice To Haves

MBA or master's degree in a related field
CPC (Certified Professional Coder) certification; CHCO or comparable healthcare compliance certification
Specialty pharmacy practice experience with high-cost injectable or buy-and-bill drug reimbursement preferred
Experience with authorization tracking and clearinghouse platforms
Experience leading offshore or distributed teams preferred
5 + years of experience in a revenue cycle management leadership role, preferable within specialty pharmacy, behavioral health, or a related healthcare setting

Responsibilities

Provide day-to-day leadership, coaching, and performance management for the Prior Authorization and Medical Billing teams
Establish and monitor key performance indicators (KPIs) such as authorization turnaround time, claim denial rates, and first pass resolution rates
Develop, document, and continuously improve standard operating procedures for prior authorization and billing workflows
Partner with payers to resolve escalated authorization delays, appeals, and reimbursement disputes
Ensure billing practices comply with payer contracts, federal and state regulations, and coding guidelines
Oversee use of authorization tracking, clearinghouse, and billing platforms, identifying opportunities for automation and system optimization
Analyze trends in denials, underpayments, and authorization delays, and implement corrective action plans
Train and develop team members, including staff working across offshore or distributed locations
Prepare regular performance reports and present findings to senior leadership
Stay current on payer policy changes, coding updates, and industry best practices in pharmacy revenue cycle management
Perform ad hoc tasks as required