Revenue Cycle Manager
$72,000–$98,000 year
On-siteSomerville, Massachusetts, United States
Job Summary
Oversee the entire billing workflow from patient intake and PCR review through claim submission, A/R follow-ups, and collections. Ensure accurate coding (HCPCS, ICD-10, ALS/BLS modifiers) and maintain strict compliance with CMS and commercial payer guidelines while leading performance improvement initiatives. Supervise all department staff, including recruiting, training, and mentoring, to maximize efficiency and cash collections. Monitor key performance indicators such as days in A/R, collection rates, and denial rates to report financial health to leadership weekly. Proactively identify root causes of claim denials, execute appeals, and implement strategies to prevent future rejections. Keep the team abreast of changes in state and federal government programs and third-party payer guidelines. Maintain knowledge of company policies and procedures at all times.
Required Qualifications
- Bachelor's degree or equivalent experience in Ambulance Finance
- 5+ Years of Medical Billing and Revenue Cycle Management experience
- 2-3 Years direct experience in EMS or Ambulance billing or related industry
- Minimum of 3 years of responsible leadership in management or supervisory role
- Expert knowledge of Ambulance fee schedules, local coverage determinations (LCDs) Medicare/Medicaid regulations and private insurance contract guidelines
- Analytical mindset with strong attention to detail
- Proficient knowledge level of healthcare administrative processes such as reimbursement policies, procedures, operations and associated billing regulations
- Extensive knowledge of Federal and State insurance programs
- Extensive experience in interpreting medical records and documentation protocols
- Proficient level of medical terminology, ICD10
- Proficiency with medical billing software and EHRs
- Superior process improvement and problem-solving skills
- Excellent ability to Communicate effectively, both verbally and in writing; strong ability to interact professionally with clinical and financial stakeholders
- Strong Analytical capabilities to gather and interpret data
- Ability to exercise sound judgment and discretion at all times
- Must be 18 years of age or older
- Ability to meet the essential duties and physical, mental and sensory requirements of the position at all times
- Comply with UDS drug screening at any and all times
- Satisfactory background check and MA CORI (Criminal Offender Record Information), verification required annually
- Verification of an acceptable motor vehicle driving record, verification required annually
- Ability to lift, carry, or move documents, files, or office equipment (typically up to 10-25 pounds)
- Exceptional organizational and time-management skills to handle daily tasks
- Ability to input data accurately and read fine statistical reports
- High-level verbal and written communication skills, including professional telephone etiquette
- Ability to manage deadlines and resolve issues
- Close vision, peripheral vision, depth perception, and ability to adjust focus to read computer screens and printed documents
- Ability to hear and understand speech in person and on the telephone
- Ability to communicate clearly in person and via phone
Desired Qualifications
- Healthcare Administration, Business, Finance, or related field preferred
- CAC, CPC or CPB preferred
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