Revenue Cycle Manager

Job Description

Job Description

Description :

This is hybrid-remote position that will be expected to balance remote work, with regularly scheduled on-site and in-person presence in Utah Clinic locations

The Manager, Revenue Cycle Management (RCM) (Orthopedics) is responsible for overseeing and optimizing the full revenue cycle process specific to orthopedic services, including billing, coding, claims management, payment posting, and patient collections. This role ensures the organization maintains regulatory compliance, timely reimbursement, and accurate financial reporting. The RCM Manager leads a cross-functional team, works closely with providers and clinical staff, and ensures that orthopedic-specific billing requirements—such as surgical coding, implant billing, and worker’s compensation claims—are effectively managed to maximize revenue and minimize denials.

• Direct all phases of the revenue cycle for orthopedic services, from charge capture and claim submission to payment posting and A / R follow-up.
• Supervise and mentor billing, coding, payment posting, insurance verification, and denial management teams.
• Ensure proper coding and billing of orthopedic procedures, surgeries, diagnostic imaging, durable medical equipment (DME), and injections.
• Analyze KPIs (e.g., days in A / R, clean claim rate, denial trends) and implement strategies for performance improvement.
• Maintain current knowledge of orthopedic payer policies, coding changes, and reimbursement updates.
• Collaborate with orthopedic surgeons and clinical teams to resolve documentation or coding issues that impact claims.
• Oversee accurate credentialing and payer enrollment processes to support uninterrupted billing.
• Establish and enforce policies and workflows that ensure compliance with Medicare, Medicaid, commercial payers, and workers’ compensation requirements.
• Manage vendor relationships (e.g., clearinghouses, outsourced services) and resolve escalated payer issues.
• Prepare financial reports and present RCM performance updates to executive leadership.
• Performs other duties as assigned.

Requirements :

Bachelor’s degree in healthcare administration, business, or a related field required; master’s degree (MBA, MHA, or similar) preferred or equivalent work experience.

Minimum 5 years in medical revenue cycle management with at least 2 years in a supervisory or managerial role; orthopedic billing experience strongly preferred.

Proficiency with orthopedic EHR / billing platforms, payer portals and clearinghouses.

Deep understanding of orthopedic procedures, surgical coding (CPT), ICD-10, payer-specific orthopedic policies, and revenue cycle compliance requirements.

Proficient Microsoft Office skills, especially Excel.

KEY CHARACTERISTICS

Team Player : Ability to work co-operatively and collaboratively with all levels of employees, management, and external customers to maximize performance and problem solving

Integrity & Accountability : Unwavering commitment to doing what is right and upholding ethical standards. Takes ownership of tasks and maintains thorough documentation.

Confidential & Compliant : Maintains confidentiality and complies with all regulatory and privacy standards.

Orthopedic-Specific Expertise : Understands the complexities of orthopedic billing, including surgical coding, global periods, DME, and workers’ comp claims.

Strategic Leadership : Guides team members toward performance goals and fosters collaboration across departments.

Analytical Thinker : Leverages data and KPIs to drive decision-making and resolve revenue cycle bottlenecks.

Process-Oriented : Implements consistent workflows to improve claim accuracy, reduce denials, and speed up collections.

Detail-Oriented : Maintains precision in documentation, auditing, and policy development.

Effective Communicator : Excellent communication skills, both verbal and written. Effectively interfaces with surgeons, billing staff, and payers to resolve issues and implement improvements.

PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus.

While performing the duties of this job, the employee is regularly required to talk and hear.

Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to : remaining seated for periods of time to perform computer-based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.)

Frequently required to stand, walk, sit, use hands to feel, and reach with hand and arms

Occasionally lift and / or move up to 20-25 pounds.

Fine hand manipulation (keyboarding).

Travel to existing or new OCP locations may be required.