Revenue Cycle Manager

Position Summary

The Operations Manager (RCM) is responsible for leading end-to-end revenue cycle operations with a strong focus on billing, prior authorization, denials, and appeals management. This role ensures operational performance, regulatory compliance, and delivery against client and organizational objectives. The Operations Manager oversees large-scale teams, manages inventory and workflow, and implements strategies to improve collections, reduce denials, and optimize revenue outcomes. This position requires a deep understanding of billing systems, payer requirements, and denial management processes, while driving cross-functional collaboration and continuous improvement. Performs other duties as assigned.

Job Roles & Responsibilities

• Lead and oversee daily operations across billing, eligibility, prior authorization, denials, appeals, AR follow-up, and payment posting functions

• Manage and develop large teams (100+ FTEs), including direct supervision, coaching, performance management, and employee development

• Direct denials management operations, including research, appeals, reimbursement analysis, and follow-up on pending claims

• Ensure timely, accurate submission of claims and resolution of accounts to maximize reimbursement and minimize denials

• Analyze reimbursement trends, payer behavior, and denial patterns to drive corrective actions and improve outcomes

• Oversee inventory management, workload distribution, and prioritization to ensure timely execution and reduce aging risk

• Collaborate with cross-functional teams (HR, IT, Compliance, Quality, Training) to support operational initiatives and process improvements

• Act as a liaison across departments to ensure alignment, communication, and execution of revenue cycle initiatives

• Monitor adherence to policies, procedures, and compliance requirements, including auditing and quality assurance activities

• Provide reporting and insights to leadership and clients, including operational performance, KPIs, and improvement plans

• Lead Monthly Business Reviews (MBRs) and support client-facing discussions

• Support hiring, onboarding, training, and ongoing development of team members

• Foster a high-performance culture focused on accountability, engagement, and retention

• Ensure proper payer setup, eligibility validation, and billing system accuracy

• Maintain confidentiality and ensure proper handling of Protected Health Information (PHI)

Qualifications & Requirements

Experience & Education

• Bachelor’s degree required (or equivalent experience)

• 8+ years of experience in end-to-end Revenue Cycle Management (RCM)

• Minimum 3+ years of leadership experience in a high-volume billing or denials management environment

• Experience managing large teams (100+ FTEs) in fast-paced operations

• Laboratory billing experience preferred

Technical & Functional Expertise

• Strong knowledge of reimbursement, billing, coding, and healthcare compliance regulations

• Deep understanding of payer eligibility, benefits, and denial management processes

• Experience with billing systems and revenue cycle platforms

• Proficiency in Microsoft Office Suite, particularly Excel and PowerPoint

• Ability to perform complex data analysis and present findings to leadership

Leadership & Behavioral Competencies

• Strong leadership and team management skills with the ability to drive performance and accountability

• Excellent communication, presentation, and stakeholder management abilities

• Strong analytical, problem-solving, and decision-making skills

• Ability to manage multiple priorities, projects, and workflows simultaneously

• Strong organizational skills and attention to detail

• Ability to collaborate effectively across all levels of the organization

• Demonstrated ability to resolve employee and operational issues efficiently

• Adaptability and ability to operate in a fast-paced, evolving environment

• Commitment to high standards of customer service and operational excellence

Performance Expectations

• Deliver consistent operational performance aligned to KPIs & client expectations

• Proactively identify and resolve operational risks, bottlenecks, and inefficiencies

• Maintain strong ownership of assigned portfolios with measurable improvements in performance

• Provide clear visibility into performance, risks, and action plans

• Lead with accountability while driving team engagement, development, and retention