Manager, Payer Rules – Revenue Cycle Optimization

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $89k - $114.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Cardinal Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1971

📦 Logistics

🏭 Manufacturing

🏥 Healthcare

💰 $78M Post-IPO Debt on 2006-08

Logistics • Manufacturing • Healthcare

Cardinal Health is a global healthcare services and products company. It provides a comprehensive range of healthcare services, including medical supply distribution, pharmaceutical distribution, and logistics solutions to various healthcare facilities such as hospitals, community health centers, and ambulatory surgery centers. Additionally, Cardinal Health offers a variety of medical products and pharmaceutical services. The company also focuses on innovative solutions to enhance healthcare delivery, through services like patient support, pharmacy management, and advanced therapy solutions. Cardinal Health is committed to supporting healthcare providers in delivering quality patient care while optimizing operational efficiency.

📋 Description

• Lead, coach, and manage a team of three FTEs. • Establish priorities, allocate work, monitor quality and productivity, develop team capabilities, and ensure timely completion of payer rule and contract implementation requests. • Oversee operational readiness for new payer contracts, renewals, amendments, and updates. • Translate payer contracts, reimbursement policies, and billing guidelines into system rules, business requirements, standard operating procedures, and controls across the revenue cycle. • Own accuracy and maintenance of payer-specific configurations within Brightree and InRule. • Partner with IT, system administrators, vendors, and clearinghouses on specifications, configuration changes, user acceptance testing, validation, and issue resolution. • Create governance for intake, prioritization, approval, documentation, auditing, and validation of payer rule changes. • Monitor Medicare, Medicaid, Medicare Advantage, commercial payer, and manufacturer policy updates and communicate impacts. • Investigate differences between contracted requirements, system configuration, and payer adjudication or reimbursement. • Analyze denials, rejections, unbilled claims, underpayments, and reimbursement variances to identify gaps and prioritize remediation. • Implement automated controls and payer-specific pre-bill edits. • Coordinate readiness, testing, training, and communication for payer rule changes; escalate risks and ensure gaps are closed. • Support Brightree transformation, integrations, and enterprise standardization efforts. • Develop metrics and report progress on implementation timeliness, configuration accuracy, denial trends, backlog, and revenue cycle improvements. • Direct oversight of policies and procedures execution. • Ensure Payer Rules FTEs operate within guidelines and remain compliant.

🎯 Requirements

• Bachelor's degree in healthcare administration, Business, Finance, Information Systems, or related field, or equivalent relevant experience preferred. • 5+ years of experience in healthcare revenue cycle, payer operations, reimbursement, billing systems, or payer rules preferred. • Demonstrated leadership or supervision of staff. • Strong knowledge of payer contractual and billing requirements, claims processing, denial management, and translating business needs into operational processes and system rules. • Experience coordinating system configurations, change controls, testing, audits, and cross-functional process improvement. • Strong analytical, communication, and problem-solving skills. • DMEPOS or medical supply reimbursement preferred. • Brightree, InRule, or comparable rules engines experience; Medicare, Medicaid, Medicare Advantage and commercial payer requirements; EDI and clearinghouse processes preferred.

🏖️ Benefits

• Medical, dental and vision coverage • Paid time off plan • Health savings account (HSA) • 401k savings plan • Access to wages before pay day with myFlexPay • Flexible spending accounts (FSAs) • Short- and long-term disability coverage • Work-Life resources • Paid parental leave • Healthy lifestyle programs • Bonus eligible