Manager, Revenue Cycle Management (RCM Vendor Operations) – Autism Specialty Services
Position Summary
The Manager, Revenue Cycle Management (RCM Vendor Operations) is responsible for overseeing the performance and effectiveness of outsourced RCM vendors supporting an autism specialty healthcare organization. This role serves as the primary liaison between internal operations, clinical teams, finance, and external billing partners to ensure accurate claims processing, reimbursement optimization, compliance, and revenue integrity.
Key Responsibilities
- Manage day-to-day relationships with RCM vendors and billing partners.
- Establish performance expectations, service level agreements (SLAs), and key performance indicators (KPIs).
- Conduct regular vendor performance reviews and business meetings.
- Escalate and resolve billing, coding, claims, and reimbursement issues.
Revenue Cycle Oversight
- Monitor the complete revenue cycle from patient intake through payment collection.
- Review claim submission accuracy, denial management, payment posting, and accounts receivable performance.
- Analyze reimbursement trends and identify opportunities to improve cash flow.
- Ensure timely filing and payer compliance requirements are met.
Autism Specialty Billing Expertise
- Oversee billing processes related to Applied Behavior Analysis (ABA) therapy and autism-related services.
- Ensure accurate use of CPT, HCPCS, and diagnosis codes applicable to autism services.
- Monitor payer authorization requirements and reimbursement policies.
- Stay current on Medicaid, commercial insurance, and managed care regulations affecting autism treatment.
Reporting & Analytics
- Develop and maintain revenue cycle dashboards and performance reports.
- Track KPIs including:
- Clean claim rate
- Denial rate
- Days in Accounts Receivable (A/R)
- Net collection rate
- First-pass resolution rate
- Authorization utilization
- Present findings and recommendations to leadership.
Compliance & Quality Assurance
- Ensure compliance with HIPAA, payer regulations, and healthcare billing standards.
- Support internal and external audits.
- Identify revenue leakage and implement corrective actions.
- Develop process improvement initiatives to enhance billing accuracy and efficiency.
Cross-Functional Collaboration
- Partner with Clinical Operations, Intake, Scheduling, Credentialing, and Finance teams.
- Provide guidance on documentation requirements impacting reimbursement.
- Support payer contract implementation and reimbursement analysis.
- Lead projects related to revenue cycle optimization.
QualificationsEducation
- Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field.
- Master's degree preferred.
Experience
- 5+ years of healthcare revenue cycle management experience.
- 3+ years of vendor management or leadership experience.
- Experience with autism services, ABA therapy, behavioral health, or pediatric specialty healthcare preferred.
- Strong understanding of commercial insurance, Medicaid, and managed care reimbursement.
Knowledge, Skills & Abilities
- Expertise in healthcare billing, coding, claims management, and denial resolution.
- Knowledge of ABA billing regulations and payer requirements.
- Strong analytical and financial management skills.
- Experience with EHR, practice management, and RCM platforms.
- Excellent communication, negotiation, and vendor management abilities.
- Ability to interpret financial and operational performance data.
Key Performance Indicators (KPIs)
- Net Collection Rate
- Clean Claim Rate
- Denial Rate
- Days in A/R
- Authorization Compliance Rate
- Vendor SLA Achievement
- Cash Collections vs. Target
- Revenue Leakage Reduction
- Patient Balance Resolution Rate
Pay: $70,627.05 - $80,882.29 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Paid time off
- Retirement plan
- Vision insurance
Work Location: Remote
