Job Title: Revenue Cycle & Enrollment Manager
Location: Remote (Fully Remote)
Job Type: Long-Term Contract
Start Date: ASAP
Job Summary
We are seeking a highly efficient, detail-oriented Revenue Cycle & Enrollment Manager to oversee our revenue cycle department and health plan enrollment operations. In this dual-focus leadership role, you will manage department staff, optimize financial workflows, and ensure the accurate processing of member enrollments, claims, billing, and appeals. You will be responsible for maintaining strict compliance with regulatory standards (CMS, ACA, HIPAA, state guidelines) while driving system efficiencies to improve overall departmental performance.
Key Responsibilities
Departmental Leadership & Operations
- Workflow Structuring: Plan, structure, and optimize department workflows, staffing models, and daily queue processing metrics.
- Team Management: Oversee the hiring, training, and performance of staff by providing regular feedback, performance reviews, and one-on-one meetings.
- Interdepartmental Collaboration: Partner with Member Services, Billing, Claims, and external insurance providers to resolve complex eligibility, coverage, and financial issues.
- Escalation Management: Efficiently resolve patient, member, and staff complaints regarding billing, collections, and enrollment discrepancies.
Revenue Cycle & Billing Oversight
- System Integrity: Implement and maintain systems to ensure accurate billing and medical coding (diagnoses/procedures) are entered into healthcare platforms.
- Financial Operations: Supervise account management, collections, cash posting, contract analysis, and the review of financial hardship applications.
- Claims & Appeals: Oversee the efficient processing of claims, denials, and appeals, proactively identifying and resolving systemic reimbursement issues.
Enrollment & Data Verification
- Application Processing: Supervise and verify incoming health plan enrollment applications, demographic updates, plan changes, and coverage terminations.
- Data Validation: Ensure exact verification of member eligibility, dependent information, supporting documentation, and qualifying life events (QLEs).
- Database Management: Oversee member data entry across internal platforms, electronic data interchange (EDI) error queues, and core database systems.
- Compliance Auditing: Guarantee strict adherence to HIPAA guidelines, health plan compliance standards, and internal turnaround time (TAT) metrics.
Required Qualifications
- Education: Bachelor’s degree in Healthcare Administration, Finance, Business Administration, or a related field.
- Experience: 2+ years of healthcare enrollment experience combined with proven supervisory experience in healthcare billing and revenue cycle management.
- Technical Skills: Advanced proficiency in Microsoft Office applications (Word, Excel, Outlook) and medical office/database software.
- Industry Knowledge: Sound knowledge of health insurance concepts (ACA, Medicare, Medicaid, premiums, eligibility periods) and health insurance providers.
- Coding Skills: Ability to correctly code medical diagnoses and procedures.
- Core Skills: Strong interpersonal, organizational, time-management, and customer service skills with an ability to maintain low error rates in a fast-paced environment.
Preferred Qualifications
- Familiarity with 834 EDI transactions.
- Experience with healthcare administration platforms (e.g., Facets, QNXT, Salesforce).
Key Competencies & Traits
- Adaptable: Quick to adopt system updates and process changes in a dynamic work environment.
- Quality-Driven: Takes pride in data precision, structural alignment, and long-term file accuracy.
- Reliable: Consistently meets regular attendance, performance benchmarks, and financial goals.
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