Overview

Description: The Revenue Cycle Manager (RCM) leads all billing, coding, claims submission, denial management, and accounts receivable functions for Summit Surgical. Operating as both a working manager and a strategic leader, the RCM oversees a team of billing and coding specialists while maintaining direct accountability for the facility's net revenue capture, payer compliance, and financial reporting accuracy.Responsibilities:Revenue Cycle OperationsOversee end-to-end revenue cycle: patient registration, prior authorization, charge capture, coding review, claims submission, payment posting, denial management, and A/R follow-up, payer contract and relationship management, Ensure timely and accurate claim submission to Medicare, Medicaid, and all commercial payers in compliance with CMS and payer-specific guidelinesMaintain clean claim rate target of =95% and monitor days in A/R against facility benchmarksManage and optimize TruBridge billing and coding modules; identify workflow improvement opportunitiesMaintain charge description master (CDM) integrity and accuracy of payer fee schedulesCoding & ComplianceReview and audit surgical, anesthesia, and facility coding for accuracy under ICD-10-CM/PCS, CPT, and HCPCS Level II guidelinesMaintain HIPAA billing compliance and adhere to OIG compliance program requirementsServe as primary liaison with Summit physicians and clinical staff on clinical documentation improvement and charge capture accuracyMonitor and implement regulatory updates from CMS, OIG, and AAPCFinancial Reporting & AnalysisProduce weekly, monthly, and quarterly revenue cycle performance dashboards for FenixMed leadership and Summit ownershipTrack and report key metrics: days in A/R, denial rate, clean claim rate, cash collections, write-off ratios, and net collection rateLead root-cause analysis on denial trends and underpayments; develop and execute corrective action plansCoordinate with FenixMed accounting team for month-end close, contractual adjustments, and bad debt reserve calculationsTeam Leadership & DevelopmentRecruit, hire, onboard, and develop billing and coding specialistsSet individual performance goals, provide regular coaching, and conduct annual performance reviewsCreate and maintain billing and coding policy and procedure documentationCoordinate continuing education and support certification maintenance for team membersPayer & Vendor RelationsManage payer contracts, credentialing timelines, and provider enrollment in coordination with FenixMedServe as primary escalation contact for complex claim disputes and payer auditsEvaluate and recommend billing technology tools, clearinghouses, or supplemental coding resources as needed Requirements: Education:Bachelor's degree in Health Information Management, Business Administration, Healthcare Administration, or related field requiredEquivalent combination of education and directly related experience may be consideredLicensure:No licensure required for this positionCertification:Preferred: Active coding or billing certification from AAPC or AHIMA Certified Professional Coder (CPC) - AAPC Certified Outpatient Coder (COC) - AAPC; preferred for surgical/ASC environment Certified Coding Specialist (CCS) - AHIMA Certified Healthcare Financial Professional (CHFP) - HFMAAnnual certification maintenance stipend provided ($500-$1,000)Experience:Minimum 5 years of progressive healthcare revenue cycle experience requiredMinimum 2 years in a supervisory, lead, or management role requiredDirect experience in a hospital, ambulatory surgery center, or physician-owned surgical facility requiredExperience with EHR/PM billing modules required; TruBridge (Netsmart) experience strongly preferredExperience managing a transition from outsourced to in-house revenue cycle operations preferredFamiliarity with Kansas Medicaid (KanCare) and regional commercial payer requirements preferredSkills:Proficiency with ICD-10-CM/PCS, CPT, HCPCS Level II, and modifier application in surgical