Revenue Cycle Manager

Tutera Senior Living & Health Care•Kansas City, MO

4d•Remote

About The Position

The Revenue Cycle Manager is responsible for the day-to-day leadership and operational oversight of the Central Billing Office supporting a multi-state portfolio of Skilled Nursing Facilities and Senior Living Medicaid Waiver communities. This position requires expert-level knowledge of Skilled Nursing Facility claims and reimbursement. The Revenue Cycle Manager must be able to independently review and troubleshoot complex SNF claims, understand how information from facility operations and PointClickCare (PCC) ultimately impacts the claim, identify billing and reimbursement errors, interpret payer and contract requirements, and provide expert guidance to billing and denial resolution staff. The Revenue Cycle Manager oversees a remote Central Billing Office team of approximately 25 employees, including billers, team leads, and denial resolution staff. The team currently supports 45+ Skilled Nursing Facilities and 5 Senior Living Medicaid Waiver communities, with the expectation that the portfolio may increase rapidly. In addition to managing daily billing operations, this position serves as a primary Revenue Cycle resource for complex payer and claim issues, denial escalation, Triple Check accuracy, facility education, revenue and cash trend analysis, and communication of reimbursement risks and cash delays to Revenue Cycle and senior leadership. The successful candidate must combine deep SNF claims expertise with strong leadership, analytical ability, attention to detail, sound judgment, and the ability to operate effectively in a fast-paced, high-pressure environment.

Requirements

Expert-level knowledge of Skilled Nursing Facility claims and reimbursement is required.
Extensive hands-on experience with SNF billing and complex claim resolution.
Strong knowledge of Medicare SNF billing requirements and reimbursement.
Strong knowledge of Medicaid, Medicare Advantage/Managed Care, Medicaid Managed Care, commercial insurance, and other third-party payer billing within the SNF environment.
Demonstrated ability to independently review and troubleshoot complex SNF claims.
Thorough understanding of how census, payer information, eligibility, authorizations, MDS/PDPM/HIPPS, clinical information, rates, ancillary services, contracts, and other data affect SNF claims.
Strong knowledge of claim edits, rejections, denials, adjustments, corrections, underpayments, and reimbursement resolution.
Ability to identify the root cause of claim and reimbursement problems rather than simply correcting individual transactions.
Working knowledge of payer contracts and the ability to interpret contract provisions affecting billing and reimbursement.
Experience with Triple Check and SNF claim validation.
Demonstrated leadership experience within Revenue Cycle, billing, collections, denial management, or a related function.
Experience managing centralized, remote, and/or multi-facility Revenue Cycle operations.
Strong analytical and critical-thinking skills.
Exceptional attention to detail.
Strong organizational and prioritization skills.
Ability to manage multiple competing priorities across a large facility portfolio.
Ability to work effectively and make sound decisions in high-pressure situations.
Strong written and verbal communication skills.
Ability to communicate effectively with frontline employees, facility leadership, regional leadership, corporate departments, and senior executives.
Strong proficiency with Microsoft Excel and Revenue Cycle reporting and analysis.

Nice To Haves

Strong experience with PointClickCare (PCC), including an understanding of how information throughout PCC flows into and impacts SNF billing and claims.
Experience managing a large remote Central Billing Office.
Experience overseeing billing operations across multiple states.
Experience leading or supporting denial resolution teams.
Experience with Medicaid Waiver billing and Senior Living reimbursement.
Experience working with payer contracting, credentialing, or payer relations teams.
Experience providing Revenue Cycle education to facility Business Office Managers and Administrators.

Responsibilities

Provide day-to-day leadership and operational oversight of a remote Central Billing Office team of approximately 25 employees, including billers, team leads, and denial resolution staff.
Oversee billing operations for 45+ Skilled Nursing Facilities and 5 Senior Living Medicaid Waiver communities across multiple states.
Establish and maintain expectations for billing accuracy, timeliness, productivity, account follow-up, documentation, and accountability.
Ensure claims are billed accurately and timely and that unresolved billing issues are appropriately prioritized and escalated.
Monitor team workloads, performance, and productivity across a large and changing facility portfolio.
Partner with team leads to identify performance concerns, knowledge gaps, and training needs.
Provide coaching, education, and technical support to billing and denial resolution staff.
Assist with hiring, onboarding, training, and development of Central Billing Office employees.
Ensure adequate team coverage and appropriate distribution of responsibilities as the organization grows or facility assignments change.
Create a collaborative environment while maintaining clear accountability for Revenue Cycle expectations and results.
Serve as a subject-matter expert for Skilled Nursing Facility claims and reimbursement.
Independently review complex SNF claims and identify errors affecting billing, reimbursement, or payment.
Maintain expert knowledge of Medicare, Medicaid, Medicare Advantage/Managed Care, Medicaid Managed Care, commercial insurance, and other payer billing requirements applicable to Skilled Nursing Facilities.
Understand how information throughout the resident and Revenue Cycle process ultimately impacts the claim, including: Census and payer information, Medicare eligibility and benefit periods, Qualifying Hospital Stay requirements, Authorizations, MDS and PDPM/HIPPS information, Clinical documentation, Rates and reimbursement methodology, Therapy and ancillary services, Coinsurance, Payer and contract requirements, Consolidated billing requirements, Claim adjustments and corrections.
Understand the complete lifecycle of a SNF claim from admission and payer verification through claim creation, submission, adjudication, payment, denial, adjustment, and final resolution.
Identify upstream errors that may result in incorrect claims, denials, underpayments, delayed reimbursement, or revenue loss.
Provide technical guidance when billing staff encounter unusual or complex claim situations.
Maintain knowledge of changing payer and regulatory requirements affecting SNF billing.
Serve as a primary escalation resource for claims that cannot be resolved through normal billing or denial resolution processes.
Assist denial resolution staff with complex Medicare, Medicaid, Managed Care, and commercial insurance denials.
Review denied, rejected, underpaid, or delayed claims to determine the underlying cause.
Ensure the team is identifying root cause rather than simply correcting individual claims.
Analyze denial trends to identify recurring issues by payer, facility, claim type, or operational process.
Determine whether recurring issues originate from billing, payer setup, authorization, census, MDS/clinical information, contract configuration, facility processes, payer processing, or another source.
Work with appropriate internal departments and payer representatives to resolve systemic reimbursement issues.
Identify opportunities for education or process correction when preventable denials are recurring.
Monitor high-value or high-risk claim issues through resolution.
Maintain a strong working understanding of payer contracts as they relate to billing and reimbursement.
Interpret reimbursement methodologies, authorization requirements, covered services, exclusions, carve-outs, filing requirements, rates, and other contractual provisions affecting claims.
Assist the billing team in determining how contract terms should be reflected in claim submission and expected reimbursement.
Identify discrepancies between contract terms, payer setup, system configuration, claims, and actual reimbursement.
Assist with payer issues that are delaying or negatively affecting reimbursement.
Partner with Payer Relations, contracting, credentialing, and other Revenue Cycle functions when issues extend beyond normal billing resolution.
Escalate significant payer or contractual concerns that may create material cash delays or revenue leakage.
Participate in and provide leadership support for the Triple Check process.
Train facility Business Office Managers and other applicable facility staff on Triple Check expectations and claim accuracy.
Ensure teams understand how information entered throughout the resident stay ultimately affects the final SNF claim.
Assist facilities with identifying discrepancies prior to claim submission whenever possible.
Review claim components and supporting information for consistency and accuracy.
Identify recurring Triple Check findings and determine whether additional facility or CBO education is needed.
Provide education regarding the financial impact of inaccurate census, payer, authorization, clinical, MDS, rate, or other information.
Work collaboratively with facility and corporate teams to reduce preventable billing errors before claims are submitted.
Monitor billing, revenue, cash collections, accounts receivable, denial activity, payer performance, and facility trends across the assigned portfolio.
Identify negative revenue and cash trends early and investigate the underlying cause.
Determine whether reimbursement delays are related to billing, payer processing, contract issues, facility execution, census or revenue changes, system configuration, authorization, clinical information, or other factors.
Analyze significant cash shortfalls and provide timely explanations of the underlying cause.
Identify potential revenue leakage or reimbursement risk and escalate material concerns.
Distinguish between expected timing differences and true Revenue Cycle performance issues.
Use data and claim-level analysis to validate conclusions rather than relying solely on anecdotal explanations.
Provide Revenue Cycle leadership with timely updates regarding significant billing, payer, denial, revenue, and cash issues.
Communicate material cash delays and their causes in real time when issues are identified.
Clearly explain what is causing a delay, the financial impact when known, actions underway, and any operational assistance needed.
Translate detailed billing and reimbursement information into concise explanations appropriate for senior and executive leadership.
Be prepared to answer questions regarding facility, payer, and portfolio-level Revenue Cycle performance.
Escalate emerging financial risks before they become significant month-end issues.
Provide accurate, fact-based analysis in high-pressure situations and when rapid decisions are required.
Work directly with facility Business Office Managers and Administrators regarding billing, claim, payer, cash, and revenue concerns.
Partner with Regional Directors of Operations and Regional Vice Presidents when facilities demonstrate negative revenue or cash trends.
Identify facilities requiring additional Revenue Cycle support based on performance and trends.
Help determine whether performance issues are related to facility execution, CBO processes, payer behavior, contracts, systems, or other factors.
Provide education and technical assistance to facility teams when operational processes are negatively affecting reimbursement.
Support facility and regional leadership with clear explanations of Revenue Cycle findings and financial impact.
Maintain productive relationships with operational leaders while ensuring accountability for processes that affect reimbursement.
Identify knowledge gaps within the CBO and facility teams based on claim errors, denials, Triple Check findings, payer issues, and revenue trends.
Develop and provide targeted education related to SNF billing and reimbursement.
Assist with onboarding and ongoing education of billers, denial staff, Business Office Managers, and other applicable personnel.
Identify recurring billing or reimbursement issues that may indicate a larger process or system concern.
Recommend improvements when existing processes contribute to billing errors, denials, delayed cash, or revenue leakage.
Help ensure billing practices remain consistent across the organization while accounting for state- and payer-specific requirements.

Benefits

Advanced Pay
Financial Literacy Classes
Employee Assistance Program offering Mental Health Resources, Legal Guidance, Financial Information, and more!
Child Care Discount
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
401(k) for Eligible Locations
Tuition Reimbursement
Paid Time Off
Holiday Pay
Exclusive Tutera Perks
Tutera University
Advancement Opportunities