[Hiring] Revenue Cycle Operations Manager @Concert Health

Role Description

Concert Health is seeking a highly motivated and experienced Revenue Cycle Operations Manager to lead and refine the daily operations of our Collaborative Care Model (CoCM) Billing Team. This high-impact leadership role is essential for maximizing clean claim submissions, optimizing revenue flow, and scaling a high-performing team to navigate increasing operational complexity. You will drive operational excellence by overseeing high-volume claims management and ensuring precise billing reviews through a commitment to continuous process improvement and the strategic use of automated systems.

Key Responsibilities

• High-Impact People Leadership & Coaching:
  • Manage and mentor a team of up to 20 RCM professionals fostering a culture of trust and accountability while building the infrastructure to support departmental scaling.
  • Lead talent management (recruitment, onboarding, coaching) to ensure team mastery of CoCM and telehealth billing nuances.
  • Guide the team's transition from manual to AI-assisted workflows.
• Operational Oversight & KPI Management:
  • Lead and optimize daily RCM operations, overseeing high fidelity, high volume charge entry across disparate systems.
  • Responsible for billing preparation and entry reviews.
  • Monitor and report on core revenue cycle KPIs, including billing efficiency and Net Collection Ratio (NCR), denial trend, and credit requests, providing data-informed recommendations for improvement.
  • Manage end-to-end client monthly reconciliation processes with key partners, acting as the primary point of contact for complex financial inquiries.
  • Monitor revenue capture and profitability of each partner.
  • Provide strategic insight to partners RCM and payer strategy groups on opportunities to improve rate or other mechanisms.
• Process Optimization & Automation:
  • Drive continuous process improvement by leveraging AI and automation tools, utilizing Lean/Six Sigma frameworks to re-engineer workflows and reduce manual interventions.
  • Implement AI-driven automated feedback loops to identify common coding errors and create actionable coaching moments for the team.
  • Provide project management support for cross-functional system enhancements and process initiatives.
  • Collaborate with the Technology and Product teams to optimize the existing tools and platforms to automate and scale.
• Billing Expertise & Compliance:
  • Serve as the subject matter expert for Collaborative Care CPT codes (99492–99494) and Behavioral Health Integration (BHI), ensuring standardized, compliant billing and documentation processes.
  • Define billing requirements and performance tracking for new services.
  • Maintain audit readiness and strict compliance with all healthcare regulations, partner, and payer requirements.
  • Maintain accurate and up-to-date documentation of all relevant billing rules and partner-specific processes.
  • Implement and oversee a consistent, methodical review process to ensure processing and coding quality.

Qualifications

• Bachelor’s degree in Healthcare Finance, MHA, or equivalent.
• 3+ years of direct people management experience in a revenue cycle or medical billing function.
• In-depth knowledge of medical billing processing protocols, payment schemes, adjustment processing, medical terminology, CPT, and revenue codes.
• Proficiency in applying standard CPT, HCPCS procedure and supply codes, and ICD diagnosis coding as per CMS guidelines.
• Extensive knowledge of Medicare, Medicaid, and commercial payer billing and reimbursement.

Preferred Qualifications

• 5+ years of Revenue Cycle Management (RCM) experience.
• Preferred: CPBC (Certified Professional Biller) or CPC (Certified Professional Coder) certification.
• Experience leading process improvement and digital transformation initiatives utilizing AI, Robotic Process Automation (RPA), or other automation tools.
• Strong project management skills with the ability to manage multiple priorities simultaneously.
• Expertise in business process consulting, defining and optimizing complex workflows across systems.
• Familiar with Excel, Word, PowerPoint, Google suite, Netsuite, and SalesForce.
• Familiarity with value-based billing models (e.g., ACO, capitation contracts).

Skills & Requirements

• Highly organized, detail-oriented, and proficient in utilizing data, reporting tools, and analysis to drive data-informed decisions and communicate insights clearly.
• Demonstrated ability to navigate complexity, change, and ambiguity, effectively leading and maintaining team organization during periods of rapid growth.
• Clear, confident communicator both written and verbal.

Benefits

• $95,000 - $123,000 base pay based on experience and geographic location.
• Fully remote work environment.
• Excellent benefits package.
• 401K, paid holidays, PTO, sick time, and more.
• Technology and all the tools you need to succeed.
• Mission-driven work that makes a meaningful impact.