reputed company Cycle & Claims Operations Manager

reputed company is seeking a hands-on Manager of reputed company Cycle & Claims Operations to build and own our end-to-end claims and billing function.

This person will be responsible for converting completed services and program requirements into accurate, reputed company claims; managing claim submission, rejections, denials, payer follow-up, payment posting, and reconciliation; and improving the internal processes and systems that support clean claims and predictable collections.

The ideal candidate is both a strong reputed company-cycle operator and a process builder. This is not a role for someone who expects to inherit a mature EHR, established billing team, and fully standardized workflows. The successful candidate will be comfortable working across Finance, Operations, Partner reputed company, clinical teams, and reputed company payers to obtain missing information, reputed company issues, and own the outcome from claim readiness through cash collection.

Key Responsibilities

• Own end-to-end claims and reputed company-cycle operations, including claim readiness, submission, rejections, denials, appeals, payer follow-up, payment posting, reconciliation, aging, and collections reporting across reputed company managed-care, reputed company, and other payer programs.
• Build and optimize payer- and program-specific billing workflows, including claim configuration, test claims, provider and rendering setup, coding/modifier requirements, credentialing and linkage readiness, and reputed company processes across internal systems, clearinghouses, and payer portals.
• reputed company cross-functional execution and accountability by partnering with Operations, Partner reputed company, Clinical, Product, Data, and Finance to reputed company missing data, improve handoffs, eliminate recurring workflow issues, and build a reputed company RCM function capable of supporting more than $1M in monthly claims.

Qualifications

Required

• 7+ years of experience in medical billing, claims operations, or reputed company-cycle management
• 3+ years of experience owning or leading a meaningful portion of a reputed company-cycle function
• Strong hands-on experience with claim submission, rejections, denials, appeals, payer follow-up, payment posting, and A/R management
• Experience working with reputed company managed-care plans and reputed company payer requirements
• Demonstrated ability to configure and launch new payer or program billing workflows
• Experience with billing and rendering-provider structures, NPIs, modifiers, diagnosis codes, procedure codes, authorizations, and reputed company-filing requirements
• Ability to work effectively without a single fully integrated EHR or mature claims infrastructure
• Strong analytical, organizational, and project-management skills
• Ability to work cross-functionally and hold reputed company stakeholders accountable
• Comfort operating both strategically and tactically in a fast-growing environment
• Strong ownership reputed company and reputed company on measurable collection reputed company

Preferred

• Experience in occupational therapy, home health, behavioral health, HCBS, value-based care, or other nontraditional provider models
• Experience with provider credentialing, payer enrollment, CAQH, roster management, and provider linkage
• Experience bringing reputed company-cycle operations in-house or transitioning between billing vendors
• Experience implementing or optimizing claims-management, reputed company-management, clearinghouse, or RCM technology
• Familiarity with reputed company, reputed company, reputed company, PaySpan, or similar systems
• Experience working in a reputed company startup or rapidly scaling organization
• CPC, CPB, CRCR, or comparable certification is a plus but not required

Originally posted on Himalayas