Overview
Concert Health is seeking a highly motivated and experienced Revenue Cycle Operations Manager to lead and refine the daily operations of our Collaborative Care Model (CoCM) Billing Team. This high-impact leadership role is essential for maximizing clean claim submissions, optimizing revenue flow, and scaling a high-performing team to navigate increasing operational complexity. You will drive operational excellence by overseeing high-volume claims management and ensuring precise billing reviews through a commitment to continuous process improvement and the strategic use of automated systems.
Key Responsibilities:
- High-Impact People Leadership & Coaching:
- Manage and mentor a team of up to 20 RCM professionals fostering a culture of trust and accountability while building the infrastructure to support departmental scaling.
- Lead talent management (recruitment, onboarding, coaching) to ensure team mastery of CoCM and telehealth billing nuances.
- Guide the team's transition from manual to AI-assisted workflows.
- Operational Oversight & KPI Management:
- Lead and optimize daily RCM operations, overseeing high fidelity, high volume charge entry across disparate systems.
- Responsible for billing preparation and entry reviews
- Monitor and report on core revenue cycle KPIs, including billing efficiency and Net Collection Ratio (NCR), denial trend, and credit requests, providing data-informed recommendations for improvement.
- Manage end-to-end client monthly reconciliation processes with key partners, acting as the primary point of contact for complex financial inquiries.
- Monitor revenue capture and profitability of each partner.
- Provide strategic insight to partners RCM and payer strategy groups on opportunities to improve rate or other mechanisms, etc.
- Process Optimization & Automation:
- Drive continuous process improvement by leveraging AI and automation tools, utilizing Lean/Six Sigma frameworks to re-engineer workflows and reduce manual interventions.
- Implement AI-driven automated feedback loops to identify common coding errors and create actionable coaching moments for the team.
- Provide project management support for cross-functional system enhancements and process initiatives.
- Collaborate with the Technology and Product teams to optimize the existing tools and platforms to automate and scale.
- Billing Expertise & Compliance:
- Serve as the subject matter expert for Collaborative Care CPT codes (99492–99494) and Behavioral Health Integration (BHI), ensuring standardized, compliant billing and documentation processes.
- Define billing requirements and performance tracking for new services.
- Maintain audit readiness and strict compliance with all healthcare regulations, partner, and payer requirements.
- Maintain accurate and up-to-date documentation of all relevant billing rules and partner-specific processes.
- Implement and oversee a consistent, methodical review process to ensure processing and coding quality.
Required Qualifications
- Bachelor’s degree in Healthcare Finance, MHA, or equivalent.
- 3+ years of direct people management experience in a revenue cycle or medical billing function.
- In-depth knowledge of medical billing processing protocols, payment schemes, adjustment processing, medical terminology, CPT, and revenue codes
- Proficiency in applying standard CPT, HCPCS procedure and supply codes, and ICD diagnosis coding as per CMS guidelines
- Extensive knowledge of Medicare, Medicaid, and commercial payer billing and reimbursement
Preferred Qualifications
- 5+ years of Revenue Cycle Management (RCM) experience
- Preferred: CPBC (Certified Professional Biller) or CPC (Certified Professional Coder) certification.
- Experience leading process improvement and digital transformation initiatives utilizing AI, Robotic Process Automation (RPA), or other automation tools.
- Strong project management skills with the ability to manage multiple priorities simultaneously.
- Expertise in business process consulting, defining and optimizing complex workflows across systems
- Familiar with Excel, Word, PowerPoint, Google suite, Netsuite, and SalesForce.
- Familiarity with value-based billing models (e.g., ACO, capitation contracts)
Skills & Requirements
- Highly organized, detail-oriented, and proficient in utilizing data, reporting tools, and analysis to drive data-informed decisions and communicate insights clearly.
- Demonstrated ability to navigate complexity, change, and ambiguity, effectively leading and maintaining team organization during periods of rapid growth.
- Clear, confident communicator both written and verbal
What We Offer
- $95,000 - $123,000 base pay based on experience and geographic location
- Fully remote work environment
- Excellent benefits package
- 401K, paid holidays, PTO, sick time, and more
- Technology and all the tools you need to succeed
- Mission-driven work that makes a meaningful impact
Come As You Are - You Are Welcome Here
Concert Health is a diverse and inclusive Equal Opportunity Employer; we prohibit discrimination and harassment of any kind in our culture. We provide a safe, equitable, respectful, and supportive work environment to all without regard to race, color, religion, sex, gender, national origin, age, pregnancy, disability, sexual orientation, military or veteran status, genetics, or any other status protected by federal, state, or local laws. This policy applies to all terms and conditions of work, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. All Concert Health employees are expected to comply with this policy. If you share our vision and are good at what you do, come as you are. You are welcome here.