Senior Manager, Back End Revenue Cycle
Job Description:
• 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
Requirements:
• 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
Benefits:
• Offers Equity
• 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
Requirements:
• 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
Benefits:
• Offers Equity