Revenue Cycle Operations Manager

Concert Health

1d•$95,000 - $123,000•Remote

About The Position

Concert Health is seeking a highly motivated and experienced Revenue Cycle Operations Manager to lead and refine the daily operations of our Collaborative Care Model (CoCM) Billing Team. This high-impact leadership role is essential for maximizing clean claim submissions, optimizing revenue flow, and scaling a high-performing team to navigate increasing operational complexity. You will drive operational excellence by overseeing high-volume claims management and ensuring precise billing reviews through a commitment to continuous process improvement and the strategic use of automated systems.

Requirements

Bachelor’s degree in Healthcare Finance, MHA, or equivalent.
3+ years of direct people management experience in a revenue cycle or medical billing function.
In-depth knowledge of medical billing processing protocols, payment schemes, adjustment processing, medical terminology, CPT, and revenue codes
Proficiency in applying standard CPT, HCPCS procedure and supply codes, and ICD diagnosis coding as per CMS guidelines
Extensive knowledge of Medicare, Medicaid, and commercial payer billing and reimbursement

Nice To Haves

5+ years of Revenue Cycle Management (RCM) experience
Preferred: CPBC (Certified Professional Biller) or CPC (Certified Professional Coder) certification.
Experience leading process improvement and digital transformation initiatives utilizing AI, Robotic Process Automation (RPA), or other automation tools.
Strong project management skills with the ability to manage multiple priorities simultaneously.
Expertise in business process consulting, defining and optimizing complex workflows across systems
Familiar with Excel, Word, PowerPoint, Google suite, Netsuite, and SalesForce.
Familiarity with value-based billing models (e.g., ACO, capitation contracts)

Responsibilities

Manage and mentor a team of up to 20 RCM professionals fostering a culture of trust and accountability while building the infrastructure to support departmental scaling.
Lead talent management (recruitment, onboarding, coaching) to ensure team mastery of CoCM and telehealth billing nuances.
Guide the team's transition from manual to AI-assisted workflows.
Lead and optimize daily RCM operations, overseeing high fidelity, high volume charge entry across disparate systems.
Responsible for billing preparation and entry reviews
Monitor and report on core revenue cycle KPIs, including billing efficiency and Net Collection Ratio (NCR), denial trend, and credit requests, providing data-informed recommendations for improvement.
Manage end-to-end client monthly reconciliation processes with key partners, acting as the primary point of contact for complex financial inquiries.
Monitor revenue capture and profitability of each partner.
Provide strategic insight to partners RCM and payer strategy groups on opportunities to improve rate or other mechanisms, etc.
Drive continuous process improvement by leveraging AI and automation tools, utilizing Lean/Six Sigma frameworks to re-engineer workflows and reduce manual interventions.
Implement AI-driven automated feedback loops to identify common coding errors and create actionable coaching moments for the team.
Provide project management support for cross-functional system enhancements and process initiatives.
Collaborate with the Technology and Product teams to optimize the existing tools and platforms to automate and scale.
Serve as the subject matter expert for Collaborative Care CPT codes (99492–99494) and Behavioral Health Integration (BHI), ensuring standardized, compliant billing and documentation processes.
Define billing requirements and performance tracking for new services.
Maintain audit readiness and strict compliance with all healthcare regulations, partner, and payer requirements.
Maintain accurate and up-to-date documentation of all relevant billing rules and partner-specific processes.
Implement and oversee a consistent, methodical review process to ensure processing and coding quality.