About the RoleWe are looking for a
Senior Manager, RCM Optimization & Strategy to find and fix the root causes of denials, front-end rejections, and revenue leakage across InStride's Revenue Cycle Management (RCM) operations. Reporting directly to the Senior Director of RCM, this high impact senior individual contributor role serves as the strategic bridge between core RCM workflows (billing, cash posting, AR, and patient collections), Payor Operations, and the analytics and technology that power them. You will own billing system setup and payor billing logic, lead root-cause analysis on denials and underpayments, and build the KPI framework the RCM team uses to measure performance. This is an individual contributor role: rather than managing the billing and AR team, you will equip the team and the Senior Director of RCM with the insights, workflows, and system fixes that make their work faster and more accurate.
You will collaborate closely with the RCM team, Payor Operations, Licensing & Credentialing, Authorization & Eligibility, Clinical Admissions, Clinical Operations, and IT to reduce front-end errors, streamline complex workflows, resolve systemic payor issues, and maximize collections. As InStride's RCM function scales, this role may have the opportunity to grow into people leadership. This is a fully remote position.
Responsibilities: - Analyze end-to-end RCM workflows, from pre-billing through denial resolution and patient collections, to eliminate manual processes, remove operational bottlenecks, and address revenue leakage. Design, test, and implement streamlined workflows in partnership with the Senior Director of RCM.
- Own billing system setup and configuration across InStride's RCM platforms (Apero, Sigma, and Mahler), including payor billing logic, fee schedules, and contract terms, to minimize revenue leakage and maximize contract yield.
- Build, maintain, and continuously refine RCM KPI dashboards (such as clean claim rate, denial rate, days in AR, claim lag, appeals, and collection rate) and share insights with the Senior Director of RCM and the team.
- Perform routine audits of billing engine rules, rule logic, and fee schedules to ensure ongoing compliance with payor guidelines and coding updates.
- Lead deep-dive root-cause analyses on claim denials and underpayments, and recommend durable fixes to the Senior Director of RCM and partner teams.
- Serve as the internal checkpoint for claims escalations raised by the billing and AR team: confirm that internal options (such as credentialing and member eligibility checks) and appeal pathways have been exhausted, and that escalation files are complete (such as member ID), before issues go to the payor.
- Partner with Technology teams to implement automation that streamlines claim submission, denials management, and revenue capture.
- Partner with Payor Operations on systemic payor issues related to claim submission and resolution, including issues that require escalation to health plans.
- Manage internal and clearinghouse configuration rules to resolve pre-claim edits and front-end rejections upstream.
- Lead recurring coordination with Licensing & Credentialing on downstream claims issues and with Authorization & Eligibility on eligibility-driven claim errors (such as an incorrect billable payor), and partner with Patient Access and Clinical Operations to reduce intake-driven denials.
- Lead change management when deploying new billing tools, software integrations, or workflow changes, partnering with the Senior Director of RCM to train and support the team.
- Deliver executive-level RCM insights, progress updates, and financial performance reporting to the Senior Director of RCM and executive leadership.
What You Need to Succeed in the Role- 6+ years of progressive healthcare revenue cycle management experience, with at least 3 years in an analytical, optimization, or process improvement capacity.
- Bachelor's degree in Healthcare Administration, Finance, Business Analytics, or a related field or 10+ years in healthcare RCM.
- Proven track record of using complex data sets to streamline RCM operations, reduce claim denials, and recover lost revenue.
- Strong project management background with demonstrated success leading cross-functional tech or process improvement projects.
- Exceptional analytical and problem-solving skills with high attention to detail.
- Clear written and verbal communication skills, with an ability to translate complex revenue cycle data into clear, actionable insights for diverse teams.
- Highly collaborative mindset with proven ability to build effective relationships across clinical, operational, and technical leadership.
- Working knowledge of insurance payor policies, billing guidelines, and claims submission requirements.
- Familiarity with CPT and ICD-10 codes and how they impact billing and reimbursement.
- Hands-on experience with payor contract analysis, fee schedule audits, and underpayment identification and recovery.
- Experience configuring billing platforms; experience with Apero, Sigma, Mahler, or similar RCM software preferred.
Additional Preferred Qualifications- Behavioral health or telehealth billing background.
- Previous experience in a fast-paced, high-growth, or startup healthcare environment.
- Hands-on experience building custom clearinghouse rules and robotic process automation (RPA)/AI solutions.
- Advanced technical mastery in SQL, BI reporting platforms (e.g., Looker, Power BI), EHR/PM systems, and clearinghouse rule builders.
- Passion for pediatric mental health and expanding access to high-quality care.
The expected annual salary for this role is between $130,000-$145,000. Actual starting salary will be determined on an individualized basis and will be based on several factors including but not limited to specific skill set, work experience, etc.
Why Join Our Team- Generous benefits package (401k with match, Flexible PTO, paid holidays, paid service days, 4 week paid sabbatical, 12 week paid parental leave, health benefits starting on your first day, and more)
- Opportunity to join a mission-driven company that is changing the landscape of pediatric mental health treatment
- Chance to make a far-reaching impact by helping children and families access desperately-needed, evidence-based care
- Opportunity to work with talented and experienced team members who have devoted their lives to solving this problem
- Fully virtual: work from the comfort of your home with periodic in-person retreats
