Senior Manager, Risk Adjustment Provider Enablement
Homeward
Director of Revenue Cycle Management
Rhythm
full-time
Posted on:
Origin: • 🇺🇸 United States • New York
Visit company websiteSalary
💰 $120,000 - $140,000 per year
Job Level
Lead
About the role
- Lead end-to-end billing and revenue cycle strategy; manage and develop a team of billing specialists.
- Oversee Revenue Cycle Systems, processes, and reporting/analysis for all claims.
- Define strategic objectives and partner with internal stakeholders and revenue cycle business partners to evaluate and improve systems and processes.
- Complete regulatory and company documentation and reporting according to schedules.
- Respond to escalated insurance billing concerns, collection law, and insurance protocol inquiries.
- Ensure compliance with federal and state legal requirements and consult outside advisors as needed.
- Manage Quality Control/Data Entry, patient billing, claims processing, and payment activities.
- Utilize data to analyze denial trends, identify root causes, and implement corrective actions.
- Review and improve RCM workflows and policies to reduce denials and increase profitability.
- Establish and own RCM KPIs (days in AR, clean claim rates, denial rate, collection effectiveness).
Requirements
- At least 7+ years of experience in revenue cycle management, including a minimum of 2 years in a leadership role.
- Must have direct team management responsibility.
- Experience using Xifin RPM systems a plus.
- Knowledge of EHR programs, Medical Terminology, ICD-10, CPT, HCPCS codes and coding processes.
- Demonstrated success in improving RCM processes.
- Thorough understanding of healthcare reimbursement and denial management processes.
- Strong leadership and communication skills.
- Knowledge of HIPAA regulations and patient confidentiality requirements.
- Demonstrated ability to successfully lead process improvement projects.
