Senior Revenue Cycle Manager

Are you an experienced revenue cycle professional who thrives in fast-paced healthcare environments? Our client is seeking a Senior Revenue Cycle Manager to oversee and manage billing and claims processing operations for a multi-location healthcare organization. This role handles a high volume of claims processing, insurance denials, appeals, contract management, prior authorization submissions, and team leadership.

Schedule: Full-time, Monday–Friday, 8:00 AM–4:30 PM

Location: Primarily based in Plymouth, with occasional travel to Waltham and Boston

• Manage all aspects of the revenue cycle, including preparing, submitting, and following up on claims to insurance companies, government payers, and third-party entities
• Collaborate with physicians, insurance companies, and internal departments to resolve billing issues, ensure accurate coding, and improve revenue cycle performance
• Ensure accurate medical coding in compliance with ICD-10, CPT, and payer guidelines
• Conduct regular chart audits to ensure documentation compliance and billing accuracy
• Submit prior authorization requests to insurance payers for procedures and treatments
• Oversee processing of high-volume claims, ensuring timely and accurate submissions aligned with payer requirements and contract terms
• Review and resolve insurance denials; lead appeals to recover revenue
• Analyze and manage insurance contract terms to ensure billing practices align with reimbursement structures and coverage policies
• Develop strategies to reduce claim denials and improve first-pass claim accuracy
• Conduct audits on billing and claims submission processes for compliance
• Manage and mentor a large billing team and credentialing staff, providing training, support, and performance management
• Develop and implement quality metrics and performance benchmarks for the billing team
• Provide ongoing training on insurance policies, payer coverage, claims processing, denial management, and best practices
• Monitor and assess team performance using KPIs; conduct reviews and implement corrective actions
• Prepare and present detailed reports on denial rates, claim accuracy, revenue cycle performance, and appeals outcomes
• Ensure team stays current with payer policy changes, insurance guidelines, and healthcare regulations
• Build and maintain strong relationships with insurance payers to ensure smooth claims resolution

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field (preferred)
• 5+ years of revenue cycle experience, with at least 3 years in management
• Strong understanding of insurance coverage policies, prior authorizations, and contract management
• Extensive experience managing insurance denials, appeals, and negotiating with payers
• Proven leadership experience managing large billing teams in a fast-paced environment
• Proficiency in billing software, practice management systems, and EHR platforms
• In-depth understanding of coding, billing procedures, and the full revenue cycle
• Excellent problem-solving and organizational skills
• Familiarity with HIPAA regulations and compliance standards

• Certification in Medical Billing and Coding (CPC, CBCS) or Revenue Cycle Management (CHFP, CRCR)
• Experience in Specialty practice management strongly preferred

• High-impact leadership role in a modernizing healthcare organization
• Opportunity to implement best practices and drive operational improvements
• Competitive benefits and a collaborative, mission-driven culture