RCM Manager- Remote

Summary

As a RCM Manager at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

• Manages the day-to-day production regimen of multiple operational groups, with a focus on technology-driven processes and financial/banking operations.
• Provides direction to operational teams, communicating departmental and organizational goals and objectives.
• Identifies and manages service improvements to increase customer satisfaction, ensuring delivery of projects meets client and company expectations and needs.
• Serves as liaison between Operations and various cross-functional groups (IT, Client Engagement), emphasizing technology integration.
• Acts as the direct escalation point for client-identified operational issues.
• Partners with functional areas or departments to integrate new, enhanced, and existing service offerings for accounts, particularly in financial services.
• Supports revenue recovery initiatives, including denial management and appeals, in alignment with client and contractual requirements.

• Supervises a team comprised of exempt, non-exempt employees, or contingent workforce with a well-defined scope, including directing daily work activities/priorities, time tracking, people recruitment and development, cost management, and workforce planning.
• Provides supervision and guidance within multiple functional areas, with a strong emphasis on technology and financial operations.
• Responsible for hiring tasks.
• Manages team and individual performance, monitoring team members’ progress on goals.
• Ensures services are provided on time and with robust quality.
• Ensures processes and procedures are documented and reviewed/updated regularly.
• Coordinates with cross-functional teams to implement client change requests, focusing on technological solutions.
• Leads team toward operational excellence by monitoring KPIs, ensuring team goals and contractual commitments are met.
• Monitors Service Level Agreements (SLAs).
• Provides and presents production data to upper management as appropriate.
• Demonstrates strong people management abilities and handles all people care-related activities.
• Creates a working environment conducive to individual growth, high performance, and continuous improvement.
• Acts as an escalation point for complex claims recovery, denial management, and appeals-related issues.
• Oversees claim recovery performance to ensure accuracy, timeliness, and compliance with contractual and regulatory requirements.
• Partners with teams to identify root causes of denials and implement process improvements to improve reimbursement outcomes.

• 3+ years of experience in revenue cycle management or healthcare operations.
• Bachelor’s degree in Business, Healthcare Administration, Finance, or related field.
• 3+ years of leadership/supervisory management experience in medical billing, coding, claims, or payer processes, and managing associated professional or clerical staff.
• 5+ years of experience in RCM or healthcare claims processing.
• Hands-on experience with healthcare claims management software/systems (e.g., Epic, Oracle, Meditech, Cerner, or similar).
• Strong communication and customer service skills.

Prior work in revenue cycle, payer relations, or healthcare appeals.

Familiarity with state and federal regulations impacting reimbursement.

Experience with high-dollar, specialty, or complex medical claims.

Minimum 3 years of documented experience directly managing frontline staff performing claims recovery, denial management, and appeals in a remote setting.

Strong working knowledge of carrier policies, medical billing guidelines, coding (ICD 10, CPT, HCPCS), and common denial rationales.

Ability to interpret EOBs, remittance advice, and carrier correspondence to determine root cause issues and next steps.

Charismatic people leader with a demonstrated ability to…