Manager, Front End Revenue Cycle

🕒 vor 7 Tagen

🐻 Alaska, Hawaii, +7 weitere Bundesländer – Remote

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

💵 $93.000 - $107.000 / Jahr

⏰ Vollzeit

🟡 Mittelstufe

🟠 Senior

💻 Frontend-Entwickler

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Virta Health

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201 - 500 Mitarbeiter

⚕️ Krankenversicherung

🧘 Wellness

Healthcare Insurance • Wellness • Health Tech

Virta Health ist ein Gesundheitsunternehmen, das sich auf die Umkehrung von Typ-2-Diabetes und die Förderung nachhaltiger Gewichtsabnahme durch einen ernährungsorientierten Ansatz konzentriert. Das Unternehmen bietet personalisierte Behandlungspläne an, die Einzelpersonen helfen, den Bedarf an Diabetesmedikamenten zu reduzieren oder zu beseitigen. Virta arbeitet mit Organisationen und Gesundheitsdienstleistern zusammen, um transformative Ergebnisse in der Stoffwechselversorgung zu erzielen. Ihr Ansatz ist evidenzbasiert und betont die Bedeutung von Lebensstil- und Ernährungsumstellungen, um dauerhafte Verbesserungen der Gesundheit und des Gewichtsmanagements zu erreichen.

Beschreibung

• Own the end-to-end member eligibility process — from receipt of client eligibility files through verification of active insurance coverage in Athena Health • Define and enforce client eligibility file completeness standards; establish intake SLA with Client Success for incomplete or missing demographic and insurance data • Implement and manage real-time eligibility (RTE) verification (using ANSI X12 270/271) transactions to confirm active coverage before claims are submitted • Develop and maintain a reconciliation process to ensure all active members in Zuora have corresponding verified records in Athena • Identify and resolve eligibility discrepancies, retroactive terminations, and coverage changes before they result in denied claims or revenue loss • Monitor eligibility-related denial trends and implement upstream controls to reduce recurrence • Oversee the accuracy and completeness of claims preparation and entry across all Virta Health products — Diabetes Reversal, Diabetes Management, and Sustainable Weight Loss • Ensure all claims are coded correctly and submitted within payer-specific timely filing windows • Monitor claim submission lag — the time between billing period close and claim submission — and establish benchmarks to reduce exposure • Work with Engineering to improve the flow of billing trigger data from Spark into Athena, reducing manual intervention in claims entry • Implement pre-submission claim scrubbing processes to improve clean claim rates and reduce first-pass rejections • Maintain working knowledge of CPT, HCPCS, and ICD-10 coding requirements relevant to Virta Health's digital health and value-based care model • Manage provider and program credentialing and payer enrollment for all applicable Virta Health providers, locations, and product lines • Ensure all providers are enrolled with payers prior to service delivery to prevent claim denials related to credentialing status • Maintain a credentialing tracking system with defined renewal timelines, expiration alerts, and re-credentialing workflows • Coordinate with Legal, HR, and Clinical Operations on provider onboarding and payer network participation requirements • Recruit, onboard, and develop front-end RCM staff including eligibility specialists, claims entry staff, and credentialing coordinators • Establish role-specific SOPs, training programs, and performance expectations for all front-end positions • Conduct regular performance reviews and provide coaching to develop staff competency in eligibility verification, coding, and claims entry • Partner with the Manager/Director of Operational Effectiveness on reporting and process improvement initiatives affecting front-end functions.

🎯 Anforderungen

• 5+ years of revenue cycle management experience with a focus on front-end functions — eligibility, claims entry, and/or credentialing • Strong working knowledge of ANSI X12 EDI transactions including 270/271 (eligibility), 837 (claims), and 835 (remittance) • Experience with Athena Health or comparable practice management/claims system • Demonstrated ability to manage cross-functional relationships with Client Success, Engineering, and clinical teams • Experience in healthcare technology, digital health, or value-based care environments preferred • Demonstrates a proactive use of AI tools to improve individual output and efficiency.

🏖️ Vorteile

• Offers Equity