Revenue Cycle Manager Utilization Management
Overview
Revenue Cycle Manager leads payer-to-cash operations at Anuvia Prevention & Recovery Center. Own end-to-end revenue cycle from intake to claim submission. Drive operational excellence and team leadership.
What You'll Do17
- 1Own end-to-end Utilization Management for Medicaid MCO Medicare and commercial payers
- 2Direct submission and tracking of authorization requests for inpatient and outpatient services
- 3Manage reauthorization work for high-frequency programs including Residential Treatment and SACOT
- 4Route medical-necessity denials to Clinical with complete appeal packets
- 5Maintain authorization system in NetSmart for all active authorizations
- 6Coordinate daily intake paperwork review and partner with admin teams
- 7Publish monthly intake accuracy scorecards by site
- 8Verify insurance eligibility using payer portals and EDI transactions
- 9Lead weekly insurance review of active client census
- 10Determine and confirm MCO enrollments and document in NetSmart
- 11Own provider contracts and renewals with MCOs and commercial payers
- 12Configure NetSmart EHR for authorization tracking and reporting
- 13Design and deliver training curriculum and job aids
- 14Process improvement initiatives using Lean Six Sigma methodologies
- 15Supervise team of five across utilization, insurance, and denials functions
- 16Maintain denial log and manage appeals process
- 17Drive clean claim submission cycle time under five business days
Requirements10
- 15+ years building ETL pipelines with Spark and Airflow
- 2Certification CRCR preferred
- 35+ years revenue cycle or utilization management experience
- 42+ years supervisory experience directing UM intake teams
- 5Experience configuring NetSmart EHR
- 6Familiarity with payer portals Availity NaviNet UHCprovider MCO systems
- 7Strong analytical skills with Excel SQL Power BI or Tableau
- 8Valid NC or SC driver's license
- 9Adaptability creativity nurturing unity vitality integrity accountability
- 10Consistent achievement focus consistent communication change management transformational leadership
Salary Insight
Salary not disclosed in listing
Location
Required Skills
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