Revenue Cycle Manager - DME

XRHealth•Needham, MA

38d•Onsite

About The Position

XRHealth America is seeking an experienced, analytical, hands-on Revenue Cycle Manager to lead the revenue cycle function for its growing DME business. The role oversees a newly established team responsible for the complete reimbursement process, from eligibility verification and prior authorization through claims submission, payment posting, denials, accounts receivable, and collections. The manager establishes clear workflows, monitors quality and productivity, trains and supports team members, and ensures work is accurate, efficient, systematic, and compliant with payer and regulatory requirements. The manager will build a scalable revenue cycle operation while working directly in operational details. As the business grows, the role will identify and implement opportunities for automation, AI, and system optimization. Direct DME revenue cycle experience is required.

Requirements

Direct DME revenue cycle experience; candidates without DME billing and reimbursement experience will not be considered.
At least five years of DME or healthcare revenue cycle experience, including two or more years in a management, supervisory, or team-lead role.
Strong knowledge of Medicare DME billing, DME MAC policies, capped rentals, documentation, proof of delivery, medical necessity, and continued-use requirements.
Experience billing Medicare, Medicaid, Medicare Advantage, and commercial insurance plans.
Experience managing claims, payment posting, denials, appeals, accounts receivable, and collections.
Working knowledge of HCPCS codes, ICD-10 codes, modifiers, prior authorization, and timely-filing requirements.
Experience developing workflows, SOPs, quality controls, and performance standards.
Strong analytical, organizational, leadership, and problem-solving skills.
Experience with DME billing systems, clearinghouses, payer portals, and reporting tools.
Advanced proficiency with Microsoft Excel.
Ability to work full-time on-site in Needham, Massachusetts.

Nice To Haves

Experience with NikoHealth.
Professional certification such as CRCR, CPC, CPB, or CMRS.
Experience with Medicare TPE reviews, payer audits, recoupments, and overpayments.
Experience implementing workflow automation, AI tools, or system integrations.
Experience in a fast-growing DME, healthcare technology, or medical device company.
Familiarity with NetSuite, HubSpot, Zendesk, or related business platforms.

Responsibilities

Lead the day-to-day work of the DME revenue cycle team.
Establish workflows, responsibilities, priorities, productivity expectations, and quality standards.
Monitor team performance and ensure work is completed accurately and on time.
Train, coach, and support team members, addressing performance and knowledge gaps.
Develop and maintain standard operating procedures and quality-control processes.
Support future hiring and team development as the business grows.
Oversee eligibility verification, intake review, prior authorization, documentation validation, claims submission, payment posting, denials, appeals, accounts receivable, and collections.
Ensure accurate and timely claim submission to Medicare, Medicaid, Medicare Advantage, commercial insurers, and other payers.
Confirm claims are supported by required documentation, including Standard Written Orders, medical records, proof of delivery, prior authorizations, and continued-use documentation.
Oversee DME rental billing, including recurring claims, capped-rental requirements, modifiers, and continued medical-necessity requirements.
Ensure proper use of HCPCS codes, ICD-10 codes, modifiers, fee schedules, and payer-specific billing rules.
Maintain current knowledge of DME MAC policies, LCDs, related policy articles, and payer requirements.
Coordinate with Operations, Logistics, Customer Success, Finance, and Compliance to resolve billing and documentation issues.
Lead denial prevention, root-cause analysis, appeals, and payer escalations.
Monitor accounts receivable aging and ensure timely follow-up on unpaid and underpaid claims.
Identify trends involving denials, payment delays, authorization failures, and avoidable write-offs.
Oversee responses to medical-record requests, payer audits, recoupments, and overpayment notices.
Implement corrective actions to improve collections and prevent recurring issues.
Evaluate existing processes and eliminate unnecessary manual work and inconsistent practices.
Identify opportunities to use automation and AI to improve accuracy, productivity, claim follow-up, and reporting.
Optimize workflows within NikoHealth and related clearinghouse, payer, financial, and reporting systems.
Partner with Operations and Technology to improve system integrations and data integrity.
Develop dashboards and report on clean-claim rate, denial rate, days in accounts receivable, aging, collections, turnaround times, write-offs, and team productivity.
Use revenue cycle data to identify risks and recommend operational improvements.
Ensure compliance with Medicare, Medicaid, commercial payer, HIPAA, DMEPOS accreditation, and applicable federal and state requirements.
Maintain controls related to billing accuracy, medical necessity, documentation, timely filing, overpayments, and claim adjustments.
Partner with Compliance on internal audits, payer audits, TPE reviews, accreditation surveys, and regulatory requests.
Translate regulatory and payer-policy changes into updated workflows and team training.