Revenue Cycle Operations Manager

We are seeking an experienced Revenue Cycle Operations Manager to oversee and optimize healthcare revenue cycle operations, including medical billing, coding coordination, claims processing, denial management, payment posting, and accounts receivable follow-up.

The ideal candidate will have strong knowledge of the U.S. healthcare revenue cycle and experience managing teams, improving operational performance, reducing claim denials, and maintaining efficient payment and collection processes.

This role will work closely with internal teams, healthcare providers, billing specialists, coding teams, and other stakeholders to ensure revenue cycle activities are completed accurately, efficiently, and within established turnaround times.

Key Responsibilities

• Oversee day-to-day revenue cycle management operations.
• Manage workflows related to medical billing, coding, claims submission, payment posting, denial management, and A/R follow-up.
• Monitor claims throughout the billing and reimbursement cycle.
• Identify the root causes of rejected and denied claims and implement corrective actions.
• Review outstanding accounts receivable and prioritize follow-up activities.
• Monitor aged A/R and develop strategies to improve collections.
• Work with billing and coding teams to improve claim accuracy and first-pass resolution.
• Track revenue cycle KPIs and prepare regular performance reports.
• Identify revenue leakage, workflow gaps, and process inefficiencies.
• Develop and implement process improvements to increase operational efficiency.
• Establish productivity and quality standards for RCM teams.
• Conduct performance reviews and provide coaching to team members.
• Coordinate with healthcare clients and internal stakeholders regarding billing and collection issues.
• Ensure billing and RCM processes follow applicable healthcare regulations and organizational policies.
• Monitor turnaround times for claim submission, payment posting, denial resolution, and A/R follow-up.
• Support the implementation and improvement of RCM technology and workflow systems.
• Prepare management reports covering collections, denials, A/R aging, claim status, and operational performance.

Key Performance Indicators

The successful candidate will be responsible for monitoring and improving metrics such as:

• Clean Claim Rate
• First-Pass Resolution Rate
• Denial Rate
• Net Collection Rate
• Days in A/R
• A/R Over 90 Days
• Outstanding A/R
• Claim Submission Accuracy
• Denial Resolution Turnaround Time
• Payment Posting Turnaround Time
• Team Productivity
• Collection Performance

Required Qualifications

• 5+ years of experience in healthcare Revenue Cycle Management.
• 2+ years of experience managing or supervising RCM teams.
• Strong understanding of U.S. healthcare billing and reimbursement processes.
• Hands-on knowledge of medical billing, claims processing, denial management, and A/R follow-up.
• Working knowledge of CPT, ICD-10-CM, and HCPCS coding.
• Experience working with healthcare providers, insurance companies, and payer processes.
• Strong analytical and problem-solving abilities.
• Experience working with RCM software, EHR/EMR, or practice management systems.
• Strong written and verbal communication skills.
• Ability to analyze operational reports and translate data into actionable improvements.
• Strong organizational and time-management skills.