Revenue Cycle Manager

Gastromed, LLC•Coral Gables, FL

About The Position

The Revenue Cycle Manager works under the general supervision of the Chief Financial Officer and is responsible for overseeing the organization’s Revenue Cycle operations, including billing, collections, payment posting, denials and appeals, accounts receivable (A/R), revenue integrity, reconciliation, and related Revenue Cycle functions. This position ensures that billing and payment processing are completed accurately and timely, with a focus on improving cash flow, reducing A/R and bad debt, preventing and resolving denials, and improving reimbursement. The Revenue Cycle Manager also coordinates Revenue Cycle activities across the organization and works with front desk, billing, collections, and other departments as needed. The ideal candidate will have strong Revenue Cycle leadership experience, hands-on eClinicalWorks (eCW) expertise, strong financial and operational analysis skills, and the ability to identify and correct issues that affect reimbursement and overall Revenue Cycle performance.

Requirements

Minimum 5–7 years of healthcare Revenue Cycle experience, including management or leadership responsibility.
Demonstrated hands-on proficiency with eClinicalWorks (eCW) practice-management and Revenue Cycle functionality required, including claim workflows, work queues, payment activity, A/R and denial management, reporting, reconciliation, and workflow troubleshooting.
Strong physician-practice billing experience.
Strong understanding of Medicare, Medicaid, commercial insurance, managed care, and payer reimbursement.
Knowledge of CPT, ICD-10, HCPCS, charge capture, claims processing, denials, appeals, and reimbursement methodologies.
Demonstrated experience managing A/R, collections, payment posting, denials, and revenue reconciliation.
Strong analytical, financial reporting, and problem-solving skills.
Experience developing KPIs, SOPs, internal controls, and performance-management processes.
Strong leadership, communication, organizational, and decision-making skills.

Nice To Haves

Experience with ambulatory surgery center, anesthesia, pathology, infusion, or other ancillary billing preferred.

Responsibilities

Direct the complete revenue cycle, including charge capture, claim submission, payment posting, collections, denials, appeals, and A/R management.
Establish and monitor departmental KPIs for Billing, Collections, Payment Posting, Denials/Appeals, and other Revenue Cycle functions.
Monitor A/R aging, collection rates, clean claim rates, denial rates, days in A/R, payment posting, and other performance indicators.
Ensure claims are submitted accurately and timely and outstanding balances are appropriately worked.
Develop and implement strategies to reduce A/R, improve cash collections, prevent avoidable denials, and maximize reimbursement.
Ensure services are appropriately documented, coded, charged, and billed in accordance with payer requirements and applicable regulations.
Monitor charge capture and coding processes to identify missed charges, coding issues, underpayments, and potential revenue leakage.
Partner with Coding and clinical teams to address documentation and coding deficiencies.
Maintain appropriate controls for contractual adjustments, write-offs, refunds, credit balances, and account corrections.
Conduct periodic reviews and audits to identify Revenue Cycle integrity and compliance risks.
Direct denial management processes, including timely follow-up, appeals, and root-cause analysis.
Identify trends involving payer denials, authorization issues, coding errors, credentialing problems, and reimbursement discrepancies.
Monitor payer reimbursement to identify underpayments and contract-related issues.
Collaborate with Credentialing and Contracting to resolve payer enrollment and reimbursement issues.
Ensure payments, adjustments, and patient collections are posted accurately and timely.
Establish controls for unapplied payments, credit balances, refunds, and posting discrepancies.
Partner with Finance to reconcile billing-system activity with bank deposits and financial reporting.
Ensure month-end Revenue Cycle reconciliations are completed accurately and within established deadlines.
Maintain hands-on proficiency in eClinicalWorks (eCW) sufficient to independently navigate, validate, troubleshoot, and audit Revenue Cycle workflows.
Navigate patient accounts, claim history, claim statuses, work queues, coding and claim-edit workflows, rejections, denials, ERA/payment activity, adjustments, and A/R.
Oversee eCW work queues, including Ready to Submit, rejected claims, payer denials, partial payments, unresolved A/R, and other Revenue Cycle exceptions.
Validate key billing elements, including payer, provider, location, place of service, authorization/referral, coding, and modifiers.
Utilize eCW/eBO reporting and analytics to monitor A/R, denials, payment posting, reconciliation, claim status, and financial performance.
Use eCW data to identify root causes and implement corrective actions to prevent recurring denials, revenue leakage, posting errors, and workflow failures.
Partner with IT/eCW Administration to optimize workflows, work queues, claim edits, reporting, user access, system configurations, and interfaces.
Maintain appropriate role-based access, audit trails, documentation, and internal controls within eCW Revenue Cycle workflows.
Provide leadership and direction to Billing, Collections, Payment Posting, Denials/Appeals, Revenue Integrity, and other assigned Revenue Cycle functions.
Establish clear productivity, accuracy, quality, and performance expectations.
Evaluate staffing levels and recommend changes based on workload, productivity, and organizational needs.
Develop and maintain standardized workflows, policies, procedures, and SOPs.
Provide ongoing training, development, and performance coaching.
Conduct regular operational meetings to review KPIs, A/R, denials, collection performance, barriers, and improvement initiatives.
Develop and maintain daily, weekly, and monthly Revenue Cycle reporting.
Provide executive leadership with accurate reporting on collections, A/R, denials, payment trends, and projected cash collections.
Identify discrepancies between billing-system reports, bank activity, and financial reporting and ensure timely resolution.
Analyze Revenue Cycle data to identify trends, risks, and opportunities for improvement.
Present Revenue Cycle performance, corrective actions, risks, and strategic improvement initiatives to executive leadership.