Time Type: Full time
Department: Patient Accounts
All Locations: 300 Ocean Avenue - Revere
Position Summary: The Revenue Cycle Manager provides oversight of billing, accounts receivable, collections, denials, and payer compliance for the Patient Accounts Department. The role ensures accurate and timely claim processing, effective Epic workflow optimization, and the management of staff and vendor resources. The manager partners with organizational leadership and Patient Accounts management to drive compliance, operational efficiency, and sustainable cash flow performance.
- Direct the daily operations of the accounts receivable team, including supervision, training, and performance management of staff.
- Oversee outsourced vendor relationships supporting AR follow-up, self-pay collections, and call center services.
- Establish department goals, productivity standards, and training protocols, ensuring compliance with payer and regulatory requirements.
- Ensure accurate and timely billing across all payer lines, including claim submission, edits, denials, write-offs, reconciliations, and appeals.
- Prepare and analyze AR performance reports, including aging, payer trends, and denial outcomes.
- Collaborate with revenue analytics staff to develop dashboards and monitor key performance indicators.
- Partner with coding education and performance staff to address documentation-related denials.
- Collaborate with revenue control to ensure accuracy in posting, reconciliation, and audit preparation.
- Engage with IT and Informatics on Epic work queue optimization, automation, and system enhancements.
- Serve as the organizational resource and subject matter expert for Epic revenue cycle workflows.
- Act as a subject matter expert for payer regulations, policies, and processes including Massachusetts Medicaid, Health Safety Net, Medicare, and other contracted NeighborHealth payers.
- Serve as liaison for patient and payer escalations, contract compliance issues, and revenue recovery initiatives.
- Maintain readiness for internal and external audits, ensuring compliance with all federal, state, and payer billing regulations.
- Uphold departmental policies and procedures to ensure workflow uniformity and adaptability to changes in rules and regulations.
EDUCATION: - Bachelor's degree from four-year college or university preferred.
EXPERIENCE:- 5+ Years of progressive healthcare revenue cycle or billing management experience.
- Demonstrated knowledge of healthcare reimbursement policies and procedures, payer regulations, and revenue cycle operations.
- Prior experience with state and federal insurance programs, particularly MassHealth, Health Safety Net, and Medicare, required.
- Experience leading and developing staff, managing outsourced vendor relationships, and collaborating across departments is essential.
- 5 + Years of PB Epic experience with revenue cycle applications, work queue management, and optimization.
- 5 + Years of organizational, analytical, and problem-solving abilities, with a commitment to compliance, accuracy, and continuous performance improvement.
