Senior Manager, Revenue Cycle Management, Provider Operations

Oscar Health•Atlanta, GA

2d•$122,212 - $160,404•Remote

About The Position

Oscar is hiring a Senior Manager, Revenue Cycle Management to lead and optimize revenue cycle operations across Oscar Medical Group (OMG). The role owns the development and execution of scalable strategies and processes that support accurate coding, compliant billing, timely reimbursement, and financial performance. The Senior Manager is a subject matter expert in professional billing and coding and partners with clinical, operations, finance, compliance, credentialing, product, and technology stakeholders to identify revenue cycle risks and opportunities and turn them into operational strategies. The position establishes performance standards, controls, reporting, and workflows across the revenue cycle. It uses data and root-cause analysis to improve revenue capture, claims performance, coding accuracy, and provider documentation, and provides OMG leadership with guidance on performance, risks, and opportunities. The role reports to the Director, Clinical Operations. This is a remote position for candidates residing in Atlanta, Georgia. Oscar notes that its approach to work may adapt over time and could potentially involve a hybrid presence at the hub office associated with the candidate’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 overall 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 working within a multi-state medical group, telehealth organization, or other complex healthcare delivery environment.
Experience working within both provider and payer environments.
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 provider education to address documentation gaps and support accurate coding.
Lead denial prevention and resolution strategies, identify systemic trends, and partner across teams on 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.