RCM Referral & Eligibility Manager

Pinnacle Healthcare Consulting

Referral & Eligibility Manager overseeing eligibility verification and authorization procurement activities for service lines. Managing team production, quality, and resolving issues within compliance standards.

Posted 4/26/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $65,000 per yearWebsite

About the role

Key responsibilities & impact

Oversee all eligibility verification and authorization procurement activities for all service lines
Responsible for the team’s production and the completion of designated KPIs
Manage the R/E process to ensure that the avoidable denial percentages are within acceptable ranges
Review and interpret monthly denial reports to identify areas of opportunity
Monitor staff for compliance of the organization’s confidentiality policy in accordance with the Health Insurance Portability and Accountability Act (HIPAA) regulations
Seek opportunities for automation and/or disruption in the traditional methods to reduce denials
Ensure staff production, quality and compliance is maintained to company standards by assigning tasks to staff and monitoring to ensure performance
Identify and resolve problems and inconsistencies
Identify opportunities to build process and communication workflows with practice staff and/or management
Assist Revenue Optimization Specialist (ROS) for R/E in staying current on all payer bulletins and communicate pertinent information to staff
Work with ROS to design, implement or evaluate staff training and performance measurement criteria
Recruit, interview and select new employees with assistance from human resources
Responsible for supervising assigned staff, including attendance, paid time off, payroll, training, corrective action and performance evaluations
Develop work schedules according to budgets and workloads
Complete all tasks assigned by the Director in a timely manner

Requirements

What you’ll need

5 years of experience in revenue cycle management firm or billing office or medical practice
Proven experience with management of staff
Practicing knowledge of the entire revenue cycle including, intake, charge entry, accounts receivable, cash application, customer service, and credentialing
Demonstrate knowledge of government and managed care program as well as industry terms
Ability to maintain HIPAA as well as other compliance requirements
Proven analytical skills

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Pinnacle Healthcare Consulting Website LinkedIn All Job Openings 201 - 500 employees Founded 1998 🤝 B2B 📋 Compliance 💸 Finance B2B
Compliance
Finance Pinnacle Healthcare Consulting is a nationally recognized healthcare consulting firm that provides strategic, financial, operational, compliance, and valuation services to healthcare organizations. The firm offers services including compensation and fair market value opinions, business valuation and transaction support, value-based care strategy, coding and compliance, revenue cycle management, real estate consulting, and life sciences transaction advisory. Pinnacle serves hospitals, health systems, physician practices, ambulatory surgery centers, digital health companies, dialysis and kidney care companies, law firms, private equity, and nonprofit organizations, delivering practical, data-driven solutions to manage risk, improve performance, and support transactional and regulatory needs. RCM Referral & Eligibility Manager 🔥 11 minutes ago 🇺🇸 United States – Remote 💵 $65k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 👔 Manager Apply Now Find Hiring Managers Customize resume for this job Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Oversee all eligibility verification and authorization procurement activities for all service lines
Responsible for the team’s production and the completion of designated KPIs
Manage the R/E process to ensure that the avoidable denial percentages are within acceptable ranges
Review and interpret monthly denial reports to identify areas of opportunity
Monitor staff for compliance of the organization’s confidentiality policy in accordance with the Health Insurance Portability and Accountability Act (HIPAA) regulations
Seek opportunities for automation and/or disruption in the traditional methods to reduce denials
Ensure staff production, quality and compliance is maintained to company standards by assigning tasks to staff and monitoring to ensure performance
Identify and resolve problems and inconsistencies
Identify opportunities to build process and communication workflows with practice staff and/or management
Assist Revenue Optimization Specialist (ROS) for R/E in staying current on all payer bulletins and communicate pertinent information to staff
Work with ROS to design, implement or evaluate staff training and performance measurement criteria
Recruit, interview and select new employees with assistance from human resources
Responsible for supervising assigned staff, including attendance, paid time off, payroll, training, corrective action and performance evaluations
Develop work schedules according to budgets and workloads
Complete all tasks assigned by the Director in a timely manner 🎯 Requirements
5 years of experience in revenue cycle management firm or billing office or medical practice
Proven experience with management of staff
Practicing knowledge of the entire revenue cycle including, intake, charge entry, accounts receivable, cash application, customer service, and credentialing
Demonstrate knowledge of government and managed care program as well as industry terms
Ability to maintain HIPAA as well as other compliance requirements
Proven analytical skills Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Senior Manager, State Product 🔥 3 hours ago AAA 5001 - 10000 🚗 Transport 👥 B2C Website LinkedIn All Job Openings Senior Manager driving profitable growth and product strategy for personal lines insurance in NY, CT, and NJ. Leading cross-functional teams and managing P&L effectively in a remote role. 🇺🇸 United States – Remote 💵 $160.2k - $213.6k / year ⏰ Full Time 🟠 Senior 👔 Manager 🦅 H1B Visa Sponsor Senior Manager, Project/Portfolio Management 🔥 4 hours ago VSP Vision Care 1001 - 5000 ⚕️ Healthcare Insurance 🛒 Retail Website LinkedIn All Job Openings Manage Portfolio Solutions project management team at VSP Vision, directing operations, stakeholder relations, and project success across functions. 🇺🇸 United States – Remote 💵 $94.5k - $152.3k / year ⏰ Full Time 🟠 Senior 👔 Manager Internal Programs Manager – IT 🔥 6 hours ago DaVita Kidney Care 10,000+ employees ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Internal Programs Manager responsible for strategic program delivery in IT, collaborating with stakeholders at DaVita. Focused on innovation and process improvements while managing project logistics. 🇺🇸 United States – Remote 💵 $85k - $135k / year 💰 Post-IPO Debt on 2021-02 ⏰ Full Time 🟡 Mid-level 🟠 Senior 👔 Manager Senior New Business Case Manager 🔥 6 hours ago Pacific Life 1001 - 5000 💸 Finance Website LinkedIn All Job Openings Senior New Business Case Manager I at Pacific Life reviewing new business applications for completeness and compliance. Collaborating with Financial Professionals for efficient application processing. 🇺🇸 United States – Remote 💵 $2.6k - $3.2k / hour ⏰ Full Time 🟠 Senior 👔 Manager 🦅 H1B Visa Sponsor Engagement Manager 🔥 6 hours ago RELX 10,000+ employees 🏢 Enterprise 🔬 Science Website LinkedIn All Job Openings Engagement Manager coordinating client engagements and managing delivery of professional services within risk solutions. Ensuring SLAs and KPIs are met across complex customer accounts. 🇺🇸 United States – Remote 💵 $95.3k - $158.8k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 👔 Manager View More Manager Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

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Hard Skills & Tools

revenue cycle managementbillingaccounts receivablecash applicationcredentialingdata analysisKPI managementstaff trainingprocess automationperformance evaluation

Soft Skills

leadershipcommunicationproblem-solvingteam managementorganizational skillsanalytical skillscompliance monitoringstaff recruitmenttask delegationworkflow development