Senior Manager, RCM Optimization – Strategy

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $130k - $145k / year

⏰ Full Time

🟠 Senior

👔 Manager

👻 Ghost score 17%

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InStride Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

💼 Consulting

🛡️ Insurance

🏥 Healthcare

💰 $26M Venture Round on 2022-10

Consulting • Insurance • Healthcare

InStride Health is a provider of specialty outpatient care for pediatric anxiety and OCD, focused on children, teens, and young adults aged 7 to 22. The company offers a research-based clinical model developed at a Harvard-affiliated medical school. InStride Health provides a dedicated care team, personalized treatment plans including individual therapy, family therapy, exposure coaching, and medication management. They aim to help young people face their fears, build resilience, and support families. The service is covered by most major insurances and available in several states such as CT, MA, ME, NH, NJ, NY, OH, PA, RI, and VA.

📋 Description

• Analyze end-to-end RCM workflows from pre-billing through denial resolution and patient collections • Eliminate manual processes, remove operational bottlenecks, and address revenue leakage • Design, test, and implement streamlined workflows with the Senior Director of RCM • Own billing system setup and configuration across Apero, Sigma, and Mahler, including payor billing logic, fee schedules, and contract terms • Build, maintain, and refine RCM KPI dashboards • Audit billing engine rules, rule logic, and fee schedules for compliance with payor guidelines and coding updates • Lead root-cause analyses on claim denials and underpayments • Serve as the internal checkpoint for claims escalations before issues go to payors • Partner with Technology teams on automation for claim submission, denials management, and revenue capture • Partner with Payor Operations on systemic payor issues • Manage internal and clearinghouse configuration rules to resolve pre-claim edits and front-end rejections • Coordinate with Licensing & Credentialing, Authorization & Eligibility, Patient Access, and Clinical Operations to reduce claim errors and intake-driven denials • Lead change management for new billing tools, software integrations, and workflow changes • Deliver executive-level RCM insights, progress updates, and financial performance reporting

🎯 Requirements

• 6+ years of progressive healthcare revenue cycle management experience, with at least 3 years in an analytical, optimization, or process improvement capacity • Bachelor’s degree in Healthcare Administration, Finance, Business Analytics, or a related field or 10+ years in healthcare RCM • Proven track record of using complex data sets to streamline RCM operations, reduce claim denials, and recover lost revenue • Strong project management background with demonstrated success leading cross-functional tech or process improvement projects • Exceptional analytical and problem-solving skills with high attention to detail • Clear written and verbal communication skills, with an ability to translate complex revenue cycle data into clear, actionable insights for diverse teams • Highly collaborative mindset with proven ability to build effective relationships across clinical, operational, and technical leadership • Working knowledge of insurance payor policies, billing guidelines, and claims submission requirements • Familiarity with CPT and ICD-10 codes and how they impact billing and reimbursement • Hands-on experience with payor contract analysis, fee schedule audits, and underpayment identification and recovery • Experience configuring billing platforms; experience with Apero, Sigma, Mahler, or similar RCM software preferred • Behavioral health or telehealth billing background preferred • Previous experience in a fast-paced, high-growth, or startup healthcare environment preferred • Hands-on experience building custom clearinghouse rules and RPA/AI solutions preferred • Advanced technical mastery in SQL, BI reporting platforms, EHR/PM systems, and clearinghouse rule builders preferred

🏖️ Benefits

• 401k with match • Flexible PTO • Paid holidays • Paid service days • 4 week paid sabbatical • 12 week paid parental leave • Health benefits starting on your first day • Fully virtual work from home • Periodic in-person retreats