Revenue Cycle and Billing Operations Lead
PM Pediatric Care
Revenue Cycle and Billing Operations Lead
PM Pediatric Care
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Senior
About the role
- Billing & Payer Project Management: Serve as a project lead on payer-related initiatives, tracking timelines, deliverables, and cross-departmental coordination.
- Support claim submission, denial management, and appeals workflows across RCM and Behavioral Health (BH) teams.
- Proactively monitor aging claims and payer issues, driving resolution through effective collaboration with billing vendors and internal stakeholders.
- Identify systemic denial trends, develop corrective action plans, and escalate complex issues appropriately.
- Ensure payer enrollments, credentialing updates, and clearinghouse requirements are on schedule and compliant.
- Data Analysis & Reporting: Build and maintain dashboards, Excel-based reports, and trackers to measure revenue cycle performance (e.g., claim turnaround time, denial rates, collections).
- Support leadership with financial forecasting, reconciliation, and variance analysis.
- Organize and present data to support audits, compliance, payer reporting, and operational reviews.
- Develop standardized templates and reporting procedures to increase visibility and efficiency across teams.
- Leadership & Operational Support: Act as a liaison between RCM leadership, billing vendors, and internal departments to ensure goals and timelines are met.
- Assist in creating and maintaining SOPs and documentation to support training and compliance.
- Drive continuous improvement by identifying workflow gaps and recommending scalable solutions.
- Support strategic initiatives by delivering insights that enhance reimbursement, reduce denials, and optimize operational efficiency.
Requirements
- 2+ years of experience in medical billing, RCM operations, or healthcare project management.
- Demonstrated experience managing projects from initiation through completion.
- Advanced Microsoft Excel skills, including pivot tables, VLOOKUP, conditional formatting, and data modeling.
- Exceptional organizational skills and the ability to manage multiple priorities in a fast-paced environment.
- Excellent written and verbal communication skills, with the ability to interface with technical and non-technical teams.
- Ability to work independently, meet deadlines, and proactively drive process improvements.
- Preferred Qualifications: Experience supporting Behavioral Health RCM functions.
- Familiarity with payer portals, EDI processes, and clearinghouse systems.
- Understanding of payer contract terms, credentialing requirements, and reimbursement methodologies.
- Experience working with outsourced billing vendors and coordinating multi-party projects.
- Prior involvement in audit preparation, payer compliance, or revenue integrity initiatives.
