Senior Manager, Revenue Cycle Management, Provider Operations

Oscar Health•Tempe, AZ

4d•Hybrid

About The Position

Oscar is hiring a Senior Manager, Revenue Cycle Management to join their Provider Operations team. This role is responsible for leading and optimizing revenue cycle operations across Oscar Medical Group (OMG). The position owns the development and execution of scalable revenue cycle strategies and processes that support accurate coding, compliant billing, timely reimbursement, and overall financial performance. This leader will serve as a subject matter expert in professional billing and coding and will partner closely with clinical, operations, finance, compliance, credentialing, and product teams to identify revenue cycle risks and opportunities and translate them into actionable operational strategies. The Senior Manager will establish performance standards, controls, reporting, and workflows across the revenue cycle while using data and root-cause analysis to drive measurable improvements in revenue capture, claims performance, coding accuracy, and provider documentation. This role will also provide strategic guidance to OMG leadership on revenue cycle performance, risks, and opportunities as the organization grows and evolves. The position reports into the Director, Clinical Operations.

Requirements

7+ years of progressive experience in healthcare revenue cycle, professional billing, coding, or related healthcare operations.
3+ years of experience leading revenue cycle programs, teams, or functions with accountability for operational and/or financial outcomes.
Advanced knowledge of professional billing and coding, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, claims management, denial management, and payer requirements.
Experience developing and executing revenue cycle strategies that improve coding accuracy, claims performance, reimbursement, and overall financial outcomes.
Experience with coding and clinical documentation integrity, including provider documentation review, provider queries, and pre- and post-bill review processes.
Demonstrated ability to analyze complex revenue cycle data, identify trends and root causes, and translate findings into actionable strategies and recommendations.
Demonstrated experience leading complex, cross-functional initiatives, partnering with clinical, operations, finance, compliance, credentialing, and other stakeholders to drive results.
Strong executive communication skills, with the ability to clearly communicate complex revenue cycle performance, risks, opportunities, and recommendations to senior leadership.

Nice To Haves

Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician-based (CCS-P), Certified Professional Medical Auditor (CPMA), or comparable coding/revenue cycle certification.
Experience leading or overseeing coding professionals and/or certified coders.
Experience working within a multi-state medical group, telehealth organization, or other complex healthcare delivery environment.
Experience working within both provider and payer environments, providing an understanding of revenue cycle from both perspectives.
Experience with risk-adjustment coding, including ICD-10/HCC documentation and coding practices.
Experience with credentialing and payer enrollment processes and their downstream impact on revenue cycle performance.
Experience managing external revenue cycle, coding, or billing vendors.

Responsibilities

Own the strategy and performance of OMG's revenue cycle function, including professional billing, coding, claims management, denials, eligibility, documentation, and related workflows.
Serve as the senior subject matter expert for coding and billing, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, and payer requirements.
Establish and monitor revenue cycle KPIs and controls, using data and root-cause analysis to improve clean claims, coding accuracy, reimbursement, denial rates, and overall financial performance.
Lead coding and documentation integrity strategies, including pre- and post-bill review, provider queries, addendums, signatures/co-signatures, identification of inappropriate documentation practices or cloning, and proactive provider education to address documentation gaps and support accurate coding.
Lead denial prevention and resolution strategies, identifying systemic trends and partnering across teams to implement sustainable corrective actions.
Partner with clinical leadership on ICD-10/HCC documentation and coding, identifying opportunities to improve accurate capture of clinically supported diagnoses.
Evaluate payer-specific performance, requirements, and coding considerations, developing strategies to address reimbursement, eligibility, claim edits, denials, and other revenue cycle issues while incorporating payer expertise into coding and operational processes.
Partner cross-functionally with Clinical Operations, Finance, Compliance, Credentialing, Product/Technology, and other stakeholders to resolve complex revenue cycle issues and support new programs and services.
Develop scalable revenue cycle policies, workflows, governance, and vendor oversight to support a growing, multi-state provider organization.
Advise OMG leadership on revenue cycle performance, financial opportunities, operational risks, and recommended strategies, leading complex initiatives from identification through implementation and measurement.
Compliance with all applicable laws and regulations.
Other duties as assigned.