GENERAL DESCRIPTION
The Platform ASC Revenue Cycle Manager is responsible for end-to-end revenue cycle leadership across Evolve Orthopedic Partners’ ambulatory surgery centers (ASC) portfolio, supporting multiple orthopedic ASCs across several markets. This role drives standardization and performance across registration/eligibility, charge capture, coding/billing, denials management, collections, and patient financial workflows to ensure compliant billing, optimal reimbursement, and a consistent patient financial experience. The Platform ASC Revenue Cycle Manager partners closely with ASC leadership, operations, clinical leadership, and payer partners, manages internal and/or outsourced revenue cycle resources, and uses data-driven insights to improve cash flow and key revenue cycle metrics. This position reports to the VP, Revenue Cycle Management (RCM) and may require occasional travel to supported markets.
RESPONSIBILITIES
- Provide revenue cycle operational leadership for multiple orthopedic ASCs across several markets; establish consistent workflows, controls, and performance expectations across sites.
- Oversee daily revenue cycle functions including registration/eligibility, authorizations (as applicable), charge capture, coding support, claim submission, payment posting, denials management, patient billing, and collections—ensuring timely and accurate execution across the portfolio.
- Drive standardized charge capture and billing processes tailored to orthopedic surgery and ASC reimbursement, ensuring correct use of CPT/HCPCS, modifiers, and bundling/edit logic; partner with clinical teams to improve documentation and reduce coding/charge errors.
- Own denials prevention and resolution across all sites: track denial trends, conduct root cause analysis, coordinate appeals, and implement corrective actions to improve clean claim rate and reduce avoidable write-offs.
- Monitor and report KPI performance (e.g., clean claim rate, days in A/R, denial rate, net collection rate, lag days, cash collections) by site and in aggregate; present insights and action plans to the VP, RCM and operational leaders.
- Manage and optimize payer-related processes, including payer portal workflows, claim edits, authorization/dispute resolution, and underpayment identification; escalate and coordinate payer issue resolution as needed.
- Oversee patient financial workflows across markets, including estimates (as applicable), deposits, statements, refunds, payment plans, and service recovery for escalations—supporting a consistent patient experience.
- Lead and/or coordinate revenue cycle team members and vendors (billing, coding, clearinghouse, collections): set SLAs, monitor productivity and quality, provide coaching, and ensure consistent delivery across sites.
- Ensure compliance and internal controls across the portfolio related to cash posting, adjustments, refunds, write-offs, HIPAA, and billing compliance; maintain audit-ready documentation.
- Partner with finance and operations on month-end close activities, including A/R reporting, unapplied cash/credits, reconciliations between clinical systems and billing systems, and support for net revenue analytics.
- Support growth initiatives by contributing to new ASC onboarding and integration: assess revenue cycle readiness, standardize workflows, train stakeholders, and stabilize performance post-go-live/acquisition.
- Maintain and enhance policies, procedures, and system configurations across practice management/EHR, clearinghouse, and payment platforms; recommend automation and process improvements to scale efficiently.
• Stay current on ASC and orthopedic reimbursement and regulatory changes (e.g., CMS ASC payment rules, payer policy updates) and translate requirements into operational guidance and training. •
QUALIFICATIONS
Education:
- Bachelor’s degree in healthcare administration, business, finance, or related field (or equivalent combination of education and experience).
- Revenue cycle or coding certification (e.g., AAPC CPC/COC, AHIMA CCS, HFMA CRCR) or equivalent, preferred.
Experience:
- 5+ years of progressive healthcare revenue cycle experience, including leadership responsibility for teams and/or vendors.
- Demonstrated experience with ASC revenue cycle and reimbursement, strongly preferred in orthopedics and/or surgical specialties with complex payer rules and high-volume procedural billing.
- Experience managing performance across multiple sites/markets (or enterprise-level service lines), including building standardized workflows and KPI governance.
- Working knowledge of CPT/HCPCS, ICD-10-CM (and ICD-10-PCS as applicable), modifiers, NCCI edits, and revenue integrity concepts.
- Experience in an MSO, PE-backed platform, or multi-site ASC environment supporting rapid growth and standardization, preferred.
- Experience with payer contract support, underpayment/variance identification, and appeal strategy for orthopedic procedures, preferred.
- Advanced Excel skills and familiarity with BI/reporting tools (e.g., dashboarding and site-level scorecards).
- Experience with ASC PM systems required, SIS Complete experience, preferred.
Performance Requirements:
- Strong proficiency with practice management/EHR systems, clearinghouse workflows, payer portals, and A/R reporting.
- Strong analytical, communication, and stakeholder management skills; ability to influence across clinical, operational, and executive partners.
- Revenue cycle leadership and accountability for outcomes
- Denials prevention, root cause analysis, and appeals management
- Operational excellence, workflow design, and change management
- Compliance mindset (HIPAA, billing compliance, documentation requirements)
- Data-driven decision making and KPI management
- Customer service orientation and patient financial experience
- Collaboration across clinical, scheduling, finance, and executive stakeholders
- High integrity and sound judgment; maintains confidentiality and ensures compliance with policies and regulations.
- Proficiency with Microsoft Excel and reporting tools; comfort working with KPIs and dashboards.
- Ability to manage multiple priorities in a fast-paced healthcare environment
- Travel as needed to other locations for training and to perform job functions.
PHYSICAL REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. This role primarily requires the ability to remain in a stationary position for extended periods, operate a computer and standard office equipment, and perform repetitive movements such as typing and using a mouse. The position may also require occasional standing, walking, and lifting or moving items up to 10–15 pounds.
This position operates in a professional office environment; hybrid or remote work arrangements may be available based on business needs. Periodic travel to practice locations, ambulatory surgery centers (ASCs), and/or vendor sites may be required.
Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
