DescriptionJob Title:Revenue Cycle Manager/Sr. Revenue Cycle Manager
Department:Revenue & Data Operations
Reports To:Director of Revenue Cycle
Supervises:Revenue Cycle Analyst, Specialist and Billing staff
FLSA Status:Exempt
Pay Grade:E4 (Manager) / E5 (Sr. Manager)
Job Type:Regular, Full-Time
AKBCU: Yes
ICPA: No
General Functions:The Revenue Cycle Manager manages the day-to-day operations of the revenue cycle, including coding, billing, eligibility verification, payment posting, denials management, and accounts receivable across multiple EHR and billing platforms. Serving as the hands-on administrator of revenue cycle systems, this position configures, troubleshoots, and maintains those platforms and executes the processes, priorities, and standards set by the Director of Revenue Cycle. The Manager works within established payer, audit, and regulatory relationships and operates within the budget and Key Performance Indicator framework defined for the function. Working in partnership with our people, the Revenue Cycle Manager develops opportunities that fulfill our endless potential by delivering efficient, compliant revenue cycle operations. The role requires strong analytical and problem-solving abilities, regulatory compliance expertise, and the ability to lead teams in meeting operational and financial targets while maintaining the highest standards of privacy and confidentiality.
Duties and Responsibilities:Revenue Cycle Manager- Lead and supervise Revenue Cycle teams in day-to-day operations, ensuring billable encounters meet all State and Federal documentation, coding compliance, and billing guidelines across multiple EHR/documentation systems.
- Manage the day-to-day revenue cycle process from charge capture through payment posting, including timely claim submission, denials management, and accounts receivable follow-up to maximize cash reimbursement.
- Serve as the hands-on system administrator for revenue cycle financial systems-directly performing configuration changes, routine optimization, and troubleshooting in collaboration with IT and vendors-under the system direction and priorities set by the Director of Revenue Cycle.
- Configure, implement, and test revenue cycle technology enhancements according to the requirements and solution direction established by the Director, validating functionality prior to release.
- Monitor performance against the Key Performance Indicators and targets established by the Director, implementing corrective actions and maintaining comprehensive documentation of all processes, procedures, and audit trails.
- Support compliance and audit activities-including preparing documentation and responses for Medicaid Self-Audits, internal audits, and external audits-within the payer, audit, and regulatory relationships maintained by the Director.
- Administer and maintain service authorization, enrollment, and credentialing processes, partnering with program staff to support participant enrollment in Medicaid and tribal insurance programs.
- Create and deliver training for intradepartmental and interdepartmental staff on documentation requirements, billing procedures, and system functionality.
- Prepare operational and performance reports on revenue cycle activity, providing data and analysis to the Director to support financial and organizational decision-making.
- Lead team development through hiring, training, performance evaluations, and daily supervision while fostering a collaborative and customer-focused work environment.
- Maintain current knowledge of Federal and State regulations, private payor policies, and industry best practices to ensure ongoing compliance and operational optimization.
- Perform hands-on User Acceptance Testing (UAT) for system updates and enhancements, coordinating with vendors, the IT department, and program teams on changes.
- Ensure strict adherence to 42 CFR Part 2 and HIPAA compliance guidelines in all billing, collections, and protected health information activities.
- Handle ad hoc reporting and special projects while maintaining confidentiality according to all applicable regulations, policies, and procedures.
- Perform all related duties as assigned.
Sr. Revenue Cycle Manager- Perform all duties and responsibilities above with an advanced level of proficiency.
- Provide guidance and mentorship to team members on complex billing, compliance, and system administration matters.
- Lead cross-functional revenue cycle initiatives and coordinate departmental input into planning efforts under the direction of the Director of Revenue Cycle.
Job Specifications:- In-depth knowledge of billing and insurance industries, including reimbursement, billing, coding, and Medicaid 1115 Waivers.
- Strong knowledge of Electronic Health Records (EHR) systems and associated billing systems, workflows, and tool administration.
- Excellent organizational and time management skills with ability to prioritize workload to meet deadlines.
- Strong problem solving and decision-making skills with exceptional attention to accuracy, details, and fact reporting.
- Excellent verbal and written communication skills with ability to quickly learn new concepts and adapt to changing regulations.
- Demonstrated ability to work in a team environment and delegate responsibly according to regulatory guidelines and scope of practice.
- Proficient with Microsoft Office Suite or related software with advanced Microsoft Excel skills.
- Experience working remotely and managing remote teams effectively.
- Highly motivated self-starter with ability to work independently.
- General knowledge and understanding of the social, health, educational, training, and cultural needs of the Alaska Native and American Indian community.
Minimum Core Competencies:CITC Values, Respectful Leadership, Professionalism, Emotional Intelligence, Problem Solving/Critical Thinking, Communication Skills.
Minimum Qualifications:- Continued employment is contingent upon completion of satisfactory state and federal fingerprint criminal background check.
- Advanced Microsoft Excel skills.
- Strong knowledge of Electronic Health Records (EHR) systems and associated billing systems, workflows, and tool administration (e.g., CareLogic, Cerner, etc.).
- Strong knowledge of claims clearinghouse functionality and tool administration (e.g., Inovalon, etc.).
- Strong knowledge of working with government and commercial payers on all aspects of claim acceptance, denials, appeals, authorizations, and enrollments.
Revenue Cycle Manager- Bachelor's Degree in Healthcare Management, related field, or certification from an accredited Coding or Revenue Cycle Management program. Relevant experience may substitute for education requirement on a year-for-year basis.
- Two (2) years of supervisory experience.
- Three (3) years of experience in medical or behavioral health billing.
- Three (3) years of relevant financial analysis, accounting, and/or financial systems experience.
Sr. Revenue Cycle Manager- Bachelor's Degree in Healthcare Management, related field, or certification from an accredited Coding or Revenue Cycle Management program. Relevant experience may substitute for education requirement on a year-for-year basis.
- Three (3) years of supervisory experience.
- Four (4) years of experience in medical or behavioral health billing.
- Four (4) years of relevant financial analysis, accounting, and/or financial systems experience.
Preferred Qualifications:- Experience with SAGE, CareLogic, and Inovalon products.
- Experience managing and liaising with vendors.
- Experience working with SAAS applications.
- Experience administering financial systems.
- Experience with Business Intelligence tools.
- Graduate degree (e.g., MS, MBA) and/or industry certification (e.g., CMA, CPA, CFA).
Physical Requirements:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
- May require prolonged periods of sitting at a desk and consistently working on a computer with repetitive motion.
- The need to occasionally move around the office to access filing cabinets, storage cabinets, and office equipment may be necessary.
- Must be able to lift up to 25 pounds occasionally by utilizing proper lifting techniques and working in a safe manner.
DisclaimerThe information provided in this description has been designed to indicate the general nature and level of work performed by incumbents within this job. It is not designed to be interpreted as a comprehensive inventory of all duties, responsibilities, qualifications and working conditions required of employees assigned to this job. Management has sole discretion to add or modify duties of the job and to designate other functions as essential at any time. This job description is not an employment agreement or contract.
