Senior Manager, Back End Revenue Cycle

🕒 Junho 8

🐻 Alaska, Hawaii, +8 estados a mais – Remoto

🐻 Alaska – Remote 🌺 Hawaii – Remote 🦞 Maine – Remote 🌶️ New Mexico – Remote 🌪️ Oklahoma – Remote 🎸 Mississippi – Remote ⚓ Rhode Island – Remote 🗿 South Dakota – Remote 🍁 Vermont – Remote 🧀 Wisconsin – Remote

💵 $117.000 - $135.000 / ano

⏰ Tempo Integral

🟠 Sênior

🔙 Engenheiro Backend

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Virta Health

SiteLinkedInTodas as Vagas

201 - 500 funcionários

🏥 Saúde

⚕️ Seguro de Saúde

🧘 Bem-estar

Healthcare • Healthcare Insurance • Wellness

Virta Health é uma empresa de saúde focada em reverter o diabetes tipo 2 e promover a perda de peso sustentável por meio de uma abordagem com prioridade na nutrição. A empresa oferece planos de tratamento personalizados que ajudam as pessoas a reduzir ou eliminar a necessidade de medicamentos para diabetes. A Virta colabora com organizações e prestadores de serviços de saúde para alcançar resultados transformadores em cuidados metabólicos. Sua abordagem é baseada em evidências e enfatiza a importância de mudanças no estilo de vida e na alimentação para obter melhorias duradouras na saúde e no controle do peso.

Descrição

• Establish and maintain active monitoring of ANSI X12 277CA claim acknowledgment transactions to confirm payers have received submitted claims • Implement a tracking and escalation process for claims that have not received 277CA acknowledgment within defined payer-specific windows • Partner with the Front End Revenue Cycle Manager and Engineering to ensure clean claim submission and minimize rejection rates at the clearinghouse level • Maintain working knowledge of clearinghouse workflows and claim status tracking capabilities • Own the Athena Health AR aging report — ensuring it accurately reflects payment status and is actively worked on a defined cadence • Establish AR follow-up workflows by payer and aging bucket, with defined SLAs and escalation paths for each tier • Drive systematic reduction of the over-180-day AR balance through targeted payer follow-up, appeals, and collections activity • Coordinate with Finance and the Manager/Director of Operational Effectiveness to ensure AR balances in Athena are accurately reflected in Zuora and NetSuite through a defined reconciliation process • Identify and escalate AR balances where the insurance collection path has been exhausted and the employer guarantee of payment clause may apply • Build and manage a structured denial work queue in Athena Health with assigned ownership, defined SLAs, and a clear resubmission process for each denial reason code • Analyze denial trends by payer, reason code, and service line to identify root causes and implement upstream controls to prevent recurrence • Prioritize denial resolution based on dollar value and timely filing window expiration — ensuring high-value, near-deadline denials are worked first • Establish appeals workflows for payer-specific appeal processes, including supporting documentation requirements and submission timelines • Monitor denial overturn rates by payer and reason code, and use outcomes data to refine appeal strategies • Partner with the Front End Revenue Cycle Manager to address eligibility-driven denials at the root — denials reflecting coverage terminations that should have been caught upstream • Manage the collections process for both claims-billed payer populations • Establish payer-specific follow-up protocols including call queues, correspondence templates, and escalation timelines • Coordinate with Client Success on employer group collections, including communication protocols and escalation to the employer guarantee of payment process when appropriate • Monitor and report on cash collection rates by payer against contracted PMPM rates, identifying and investigating variances • Recruit, onboard, and develop back-end RCM staff including AR follow-up specialists, denial management analysts, and collectors • Establish competency requirements, training programs, and performance expectations for all back-end positions — with particular emphasis on experienced denial management and collections hires • Conduct regular AR review sessions with staff to ensure accounts are being worked effectively and escalations are appropriate • Build a culture of accountability, data-driven decision making, and continuous improvement within the back-end team

🎯 Requisitos

• 7+ years of revenue cycle management experience with a focus on back-end functions — AR management, denial management, and collections • Deep expertise in payer-specific denial reason codes, appeal processes, and timely filing requirements across major commercial payers • Demonstrated experience reducing AR aging and improving denial overturn rates in a complex payer environment • Experience with Athena Health or comparable practice management and claims system — specifically AR follow-up and denial management workflows • Proven ability to build and lead a collections and denial management team • Demonstrates a proactive use of AI tools to improve individual output and efficiency

🏖️ Benefícios

• Offers Equity