Senior Manager, Revenue Cycle Management, Provider Operations

Oscar Health•Dallas, TX

4d•$122,212 - $160,404•Remote

About The Position

Oscar is hiring a Senior Manager, Revenue Cycle Management for its Provider Operations team. The role leads and optimizes revenue cycle operations across Oscar Medical Group (OMG), developing and executing scalable strategies and processes that support accurate coding, compliant billing, timely reimbursement, and financial performance. The Senior Manager serves as a subject matter expert in professional billing and coding and partners with clinical, operations, finance, compliance, credentialing, product, and other stakeholders to identify revenue cycle risks and opportunities and turn them into operational strategies. The role establishes performance standards, controls, reporting, and workflows across the revenue cycle, using data and root-cause analysis to improve revenue capture, claims performance, coding accuracy, and provider documentation. It also provides strategic guidance to OMG leadership on performance, risks, and opportunities as the organization grows. The position reports to the Director, Clinical Operations. This is a fully remote position open to candidates residing in Dallas, Texas. Oscar notes that its work model may adapt over time and could potentially involve a hybrid presence at the hub office associated with the employee's metro area.

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 financial outcomes.
Experience with coding and clinical documentation integrity, including provider documentation review, provider queries, and pre- and post-bill review processes.
Ability to analyze complex revenue cycle data, identify trends and root causes, and translate findings into actionable strategies and recommendations.
Experience leading complex cross-functional initiatives and partnering with clinical, operations, finance, compliance, credentialing, and other stakeholders to drive results.
Strong executive communication skills, including the ability to 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 within a multi-state medical group, telehealth organization, or other complex healthcare delivery environment.
Experience in both provider and payer environments, with 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 and co-signatures, identifying inappropriate documentation practices or cloning, and proactive provider education.
Lead denial prevention and resolution strategies, identify systemic trends, and partner 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, and develop strategies addressing reimbursement, eligibility, claim edits, denials, and other revenue cycle issues.
Partner 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 for a growing, multi-state provider organization.
Advise OMG leadership on revenue cycle performance, financial opportunities, operational risks, and recommended strategies; lead complex initiatives from identification through implementation and measurement.
Comply with all applicable laws and regulations.
Perform other duties as assigned.