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Pacific Health Group
Pacific Health Group
51 – 200 Angajați
Asistență medicalăImpact socialStare de bine
Pacific Health Group este o organizație de sănătate axată pe comunitate, care sprijină populațiile insuficient deservite prin programe integrate de îngrijire medicală, sănătate comportamentală și asistență socială. Activitatea sa include gestionarea îmbunătățită a îngrijirii pentru persoanele cu nevoi complexe, tratamentul pentru probleme de sănătate comportamentală și consum de substanțe, acțiuni de informare desfășurate de lucrători comunitari din domeniul sănătății, medicină stradală pentru persoanele fără adăpost, sprijin în domeniul locuirii și transport medical pentru persoanele care nu se pot deplasa. Colaborând cu planuri de sănătate și parteneri comunitari din mai multe locații, organizația adoptă o abordare holistică pentru îmbunătățirea sănătății, accesului și echității.
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Locurile de muncă ale companiei

Revenue Cycle Manager – Hybrid

Lead revenue cycle operations for Pacific Health Group’s community healthcare programs, overseeing billing, claims, collections, denials, reimbursement, compliance, and team performance. Improve cash flow, reporting accuracy, operational controls, and payer outcomes.

USStatele Unite ale AmericiiCACalifornia
85.000 $ – 90.000 $ / an
HibridNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăManager

Descriere

  • Direct daily operations and performance across Pacific Health Group’s Revenue Cycle function
  • Manage billing, coding, claim submission, payment posting, accounts receivable, collections, denials, appeals, and reimbursement activities
  • Create workflows, internal controls, performance standards, and accountability practices
  • Verify that claims and encounters are accurate, timely, well documented, and aligned with payer requirements
  • Track outstanding, rejected, denied, unpaid, and underpaid claims through resolution
  • Detect revenue leakage, reimbursement delays, operational obstacles, and documentation gaps
  • Design and implement corrective actions and preventive measures
  • Oversee receivables, collections, aging balances, adjustments, refunds, credit balances, and write-offs
  • Manage denial and rejection workflows, root-cause reviews, corrected claims, appeals, and recovery performance
  • Act as the primary Revenue Cycle liaison for health plans, insurers, and other payers
  • Reconcile claims, encounters, payments, expected reimbursement, remittances, and payer discrepancies
  • Support payer contracts, fee schedules, billing requirements, and reimbursement methodologies
  • Partner with Operations, program leadership, Quality Assurance, Finance, Information Technology, health plans, and other stakeholders
  • Perform billing, coding, claims, payment posting, collections, and compliance audits
  • Maintain compliance with payer rules, healthcare billing regulations, contracts, HIPAA, PHI safeguards, and organizational policies
  • Produce Revenue Cycle reports, dashboards, performance analyses, and leadership recommendations
  • Support month-end revenue reconciliation and investigate reimbursement variances
  • Supervise, coach, train, and assess assigned Revenue Cycle team members
  • Set and track individual and departmental KPIs covering productivity, quality, accuracy, and timeliness
  • Create and maintain Revenue Cycle policies, procedures, workflows, and standard operating procedures
  • Lead process improvement and automation efforts to reduce denials, aging receivables, write-offs, and reimbursement delays
  • Escalate material financial, compliance, operational, and payer risks to the Directors of Community Health & Operations

Cerințe

  • At least five years of progressive experience in healthcare revenue cycle management, medical billing, reimbursement, coding, healthcare finance, or a related field
  • Prior supervisory or management experience in Revenue Cycle operations
  • Proven experience overseeing billing, claims, accounts receivable, collections, denials, appeals, and reimbursement processes
  • Strong working knowledge of ICD-10, CPT, HCPCS, modifiers, and healthcare billing practices
  • Thorough understanding of managed care reimbursement, payer requirements, claims adjudication, and payer contract administration
  • Knowledge of healthcare billing compliance, HIPAA, and PHI protection requirements
  • Proficiency with healthcare billing platforms, EHR systems, reporting tools, and Microsoft Office, especially Excel
  • Strong analytical ability, including trend identification, root-cause analysis, and corrective action planning
  • Ability to lead teams, establish accountability, manage performance, and oversee complex workflows
  • Excellent written and verbal communication skills
  • Strong organization, attention to detail, independent judgment, and ability to manage competing priorities and deadlines
  • Bachelor’s degree in Healthcare Administration, Finance, Accounting, Business Administration, or a related field; equivalent relevant experience may be considered preferred
  • CPC, CRCR, CRCP, or comparable professional credential preferred
  • Experience with Medi-Cal and California managed care organizations preferred
  • Experience supporting CalAIM Enhanced Care Management, Community Supports, Community Health Worker programs, Behavioral Health, or similar community-based healthcare services preferred
  • Experience managing multiple payer relationships and reimbursement methodologies preferred
  • Experience implementing or optimizing healthcare billing systems and automated Revenue Cycle workflows preferred
  • Experience working in a rapidly growing healthcare organization preferred
  • Ability to maintain confidentiality and protect financial, member, payer, and protected health information
  • Ability to collaborate across departments while retaining clear accountability for Revenue Cycle responsibilities

Beneficii

  • Remote work arrangement
  • Flexible schedule aligned with organizational needs
  • Occasional in-person attendance for meetings, training, departmental activities, or organizational events
  • Full-time Monday–Friday schedule from 8:30 AM to 5:00 PM

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