Manager - Revenue Cycle Operations

Job Title

Experience

Shift Time

Company Website: https://www.modulemd.com

Profile Overview

We are seeking a

• Billing Operations Oversight

• Compliance & Regulatory Adherence

• Team Leadership & Training

• Reporting & Analytics

• Vendor & Payer Relations

• Process Improvement

• Patient Billing & Support

The ideal candidate will have

The Medical Billing Manager drives efficiency in workflows, monitors key performance metrics, and resolves complex billing and reimbursement issues to support the organizations financial performance. The role also includes end-to-end oversight of medical billing functions from claims submission and payment posting to patient collections and denial management ensuring timely and accurate revenue capture.

Role Purpose:

1.

• Manage day-to-day medical billing operations, including claim submission, follow-ups, payment posting, and collections, AR, Denials, appeals, Patient Billing and managing Client accounts.

• Ensure accuracy and timeliness of claims processing for government (Medicare/Medicaid) and commercial payers.

• Review of claims to ensure they are clean to avoid rejections

• Review rejections and file corrected claims.

• Research and appeal denied claims.

• Access carrier websites for claim and eligibility information

• Interpret and process Explanation of Benefits.

• Monitor client accounts and provide weekly updates identifying issues and possible resolutions.

• Post payments

• Bill patients for responsible portions and have the ability to relay information regarding copays, deductibles and coinsurance.

• Answer patient calls regarding statements and balances.

2.

• Oversee the full revenue cycle from charge capture to payment posting and denial resolution.

• Monitor key metrics like days in A/R, denial rates, and collections.

• Client resolution - Interact professionally with medical offices and their staff on behalf of ModuleMD providing education and information to assist in retention and improve revenue.

3.

• Ensure billing practices comply with HIPAA, CMS, and payer regulations.

• Stay updated with coding changes (ICD, CPT, HCPCS) and payer policies.

4.

• Supervise and train billing specialists/coders.

• Conduct performance reviews, assign tasks, and provide ongoing coaching.

5.

• Generate regular financial and operational reports (A/R aging, collection trends, denial analysis).

• Provide insights to leadership to improve efficiency and reduce revenue leakage.

6.

• Communicate with insurance companies for claim disputes and escalations.

• Collaborate with external vendors (EHR/RCM software providers).

7.

• Identify gaps in billing workflows and implement process improvements.

• Standardize procedures to minimize denials and maximize reimbursements.

8.

• Oversee patient billing, statements, and inquiries.

• Ensure patient-friendly billing practices while maintaining collections

Denial Management Duties

9.

• Identify, track, and analyze claim denials from payers.

• Categorize denials (technical, clinical, administrative, coding-related).

10.

• Investigate patterns of recurring denials.

• Determine root causes (e.g., incorrect coding, missing documentation, eligibility issues).

11.

• Correct claim errors and resubmit to payers.

• Appeal denied claims within payer deadlines.

• Work with providers to obtain additional medical records or documentation.

12.

• Implement process improvements to reduce future denials.

• Collaborate with coding, registration, and clinical staff to prevent errors at the front end

• Monitor client accounts and provide weekly updates identifying issues and possible resolutions.

13.

• Maintain denial logs and track success rates of appeals.

• Report denial trends and financial impact to management.

14.

• Contact insurance companies for clarification, dispute resolution, or escalation.

• Maintain updated knowledge of payer policies and guidelines.

15.

• Train billing and coding staff on common denial reasons and prevention methods.

• Share best practices across departments.

16. We need Strong understanding of all downstream revenue cycle like Payment Posting, AR Follow-up and Denial Management, appeals and Patient Billing.

17.Strong understanding of revenue cycle management and KPIs standards set to optimize insurance collection and Client SLA, Strong interpersonal skills and ability to liaise with support function.

Must-Have Skills:

• Strong understanding of RCM end and 10+ years of experience in US Healthcare provider side AR.

• Experience in quality audits, team mentoring, and process improvements

• Excellent communication and reporting skills

• Coaching & development of the subordinates through training need identification.

• Experience with electronic health records (EHR) systems, prior authorization software, and Microsoft Office Suite.

• Strong analytical skills to interpret data, identify trends, and make informed decisions.

• Experience with electronic health records (EHR) systems.

• Hands-on experience with TriZettos platforms (e.g., STEM portal, Facets, or QNXT) or similar clearinghouse systems (e.g., Waystar, Availity) is highly preferred.

• Knowledge of healthcare compliance standards, including HIPAA and payer-specific regulations and other healthcare compliance standards.

• Prior experience in a client-facing role, providing training or technical support.

Nice-to-Have Certifications:

Certifications: Certified Revenue Cycle Professional (CRCP) or similar certification.

Technical Knowledge:

• Experience with electronic health records (EHR) systems.

• Strong skills in Denial management, Payment Posting, AR Follow-up, Appeals and Patient Billing with strong Knowledge of the US healthcare industry and RCM.

• Proficiency in computer applications, PMS, Excel, and PPT.

• 10+ years of experience in US Healthcare provider side AR.

Required Qualifications

• Education: Bachelors degree Healthcare Administration, or a related field.

• Minimum of 10 years of experience in revenue cycle management in US Healthcare provider side AR. And minimum 4-5 years working experience as a Manager for RCM process.

• Strong understanding of medical billing, coding, and collections processes.

• Proficiency in RCM software and Microsoft Office Suite.

• Excellent communication and interpersonal skills to interact with clients and payers.

• Proficiency in Microsoft Office (Excel, Word, Outlook).

• Detail-oriented with strong organizational and problem-solving skills.

• Ability to multitask in a fast-paced environment and meet deadlines.

Why Join ModuleMD?

• Youll work at the intersection of AI and healthcare—real-world impact every day.

• Opportunity to work on cutting-edge healthcare technology and onboarding processes.

• Join a tight-knit, mission-driven team that values curiosity, autonomy, and innovation.

• Flexible work environment and a culture of continuous learning.

Application Process:

Equal Opportunity Statement:

Ready to Join the Future of Healthcare AI?

Apply now with your GitHub/portfolio link and CV.