DescriptionJob Title: Revenue Cycle Management Manager
Department: Corporate
Location: Corporate Office - Hybrid
Position Type: Full-Time
Reports To: Director of Patient Access and Behavioral Health Services
FLSA Status: Exempt
Job Overview:
In the Revenue Cycle Management Manager role, you will work under the supervision of the Director of Patient Access and Behavioral Health Services. You will lead and oversee the company's centralized Prior Authorization team and Medical Billing team, ensuring that both functions operate efficiently, accurately, and in full compliance with payer and regulatory requirements. You will be responsible for the end-to-end revenue cycle performance of these teams - from initial authorization through claim submission, reimbursement, and denial resolution - while building processes that reduce turnaround times and maximize approval and collection rates.
You will also assist in developing training programs for staff, identifying opportunities for automation and workflow improvement, and partnering with clinical and operations leaders to resolve complex payer or billing issues affecting patient access to care.
Success in this role will be demonstrated by measurable improvements in prior authorization turnaround time, first-pass claim acceptance rates, denial reduction, and staff productivity - along with a well-trained, engaged team capable of scaling with the organization's growth.
Benefits:
- Medical/Vision/Drug Insurance
- 401k Plan with Matching up to 5%
- Tuition Reimbursement Program
- 9 Holidays and 2 Floating Holidays based on tenure
Responsibilities:
- Provide day-to-day leadership, coaching, and performance management for the Prior Authorization and Medical Billing teams
- Establish and monitor key performance indicators (KPIs) such as authorization turnaround time, claim denial rates, and first pass resolution rates
- Develop, document, and continuously improve standard operating procedures for prior authorization and billing workflows
- Partner with payers to resolve escalated authorization delays, appeals, and reimbursement disputes
- Ensure billing practices comply with payer contracts, federal and state regulations, and coding guidelines
- Oversee use of authorization tracking, clearinghouse, and billing platforms, identifying opportunities for automation and system optimization
- Analyze trends in denials, underpayments, and authorization delays, and implement corrective action plans
- Train and develop team members, including staff working across offshore or distributed locations
- Prepare regular performance reports and present findings to senior leadership
- Stay current on payer policy changes, coding updates, and industry best practices in pharmacy revenue cycle management
- Perform ad hoc tasks as required
Required Skills:
- Strong understanding of payer coverage, prior authorization, and reimbursement processes
- Proven ability to lead, motivate, and develop a team in a fast-paced, metrics-driven environment
- Excellent analytical skills, with the ability to interpret revenue cycle data and translate it into actionable process improvements
- Strong knowledge of medical billing and coding practices, payer requirements, and denial management strategies
- Excellent verbal and written communication skills, with the ability to interface confidently with payers, providers, and internal leadership
- Proficiency with revenue cycle management, clearinghouse, and authorization tracking software
- Strong organizational and project management skills, with the ability to manage multiple priorities and deadlines
- Sound judgement and problem-solving skills when handling escalated or complex reimbursement issues
Education and Experience:
- MBA or master's degree in a related field
- CPC (Certified Professional Coder) certification; CHCO or comparable healthcare compliance certification
- Specialty pharmacy practice experience with high-cost injectable or buy-and-bill drug reimbursement preferred
- Experience with authorization tracking and clearinghouse platforms
- Experience leading offshore or distributed teams preferred
- 5+ years of experience in a revenue cycle management leadership role, preferable within specialty pharmacy, behavioral health, or a related healthcare setting
Working Conditions:
- Full-time, typically requiring 40+ hours per week
- Work is performed in an office setting
- Prolonged periods sitting at a desk and working on a computer
- Must be able to lift up to 15 pounds at times
Pay Range $100,000.00 None to $120,000.00 None
