Revenue Cycle Manager

1 day ago

Noida, Uttar Pradesh, India Extreme Agile Full time ₹ 12,00,000 - ₹ 36,00,000 per year

The SNF Revenue Cycle Manager oversees all billing, coding, A/R, and collections to ensure proper reimbursement for skilled nursing facility services. The ideal candidate will have a deep understanding of PDPM (Patient-Driven Payment Model), Medicaid eligibility and billing, managed care contracts, and long-term care reimbursement models. They will lead the billing, coding, accounts receivable (A/R), and compliance teams to ensure regulatory adherence and financial stability

Key Responsibilities:

1. Revenue Cycle Oversight

  • Develop and implement strategic plans to optimize the revenue cycle for multiple SNF locations.
  • Oversee Medicare, Medicaid, Managed Care, and Private Pay billing workflows.
  • Ensure PDPM accuracy in reimbursement calculations and billing.
  • Monitor revenue cycle KPIs (Days in A/R, Denial Rates, Clean Claim Rates, Collections).

2. Billing & Claims Management

  • Ensure timely UB-04 claim submissions for SNF services.
  • Work with billing teams to reduce denials and improve first-pass claim acceptance rates.
  • Implement best practices for Medicaid pending claims and eligibility management.
  • Oversee coordination between MDS assessments and PDPM billing compliance.

3. Accounts Receivable & Collections

  • Develop A/R management strategies to reduce aging over 90+ days.
  • Ensure timely collections from insurance payers and private-pay residents.
  • Oversee denial management and appeals to maximize reimbursements.
  • Implement patient responsibility collection procedures, including Medicaid spend-down processing.

4. Compliance & Regulatory Adherence

  • Ensure compliance with CMS regulations, HIPAA, and state Medicaid guidelines.
  • Monitor Medicare PDPM updates, Medicaid changes, and managed care contract requirements.
  • Lead internal audits to prevent fraud, overpayments, and compliance risks.
  • Serve as the primary liaison with state Medicaid agencies and CMS auditors.

5. Leadership & Team Management

  • Manage and mentor a team of billing specialists, coders, A/R analysts, and compliance staff.
  • Collaborate with MDS coordinators, facility administrators, and finance teams.
  • Implement continuous training programs for billing and compliance teams.

6. Financial Reporting & Analysis

  • Generate monthly revenue cycle performance reports for senior leadership.
  • Analyze payer trends and denial patterns to improve cash flow.
  • Provide budget forecasts and financial projections related to reimbursements.

Requirements:

  • Experience: 7+ years in revenue cycle management, with 3+ years in SNF/LTC billing leadership.

  • Expertise:

  • Deep knowledge of PDPM, RUG-IV, and Medicaid case-mix reimbursement models.

  • Strong experience in Medicare, Medicaid, and Managed Care contracts.
  • Proficiency in SNF billing software (PointClickCare, MatrixCare, AHT, or similar).

  • Familiarity with CMS audit processes, ADRs, and compliance programs.

  • Skills:

  • Strong leadership and team management abilities.

  • Excellent analytical and financial acumen.
  • Strong problem-solving and negotiation skills for payer disputes.
  • Effective communication with executive teams and facility administrators.

Preferred Certifications:

  • Certified Revenue Cycle Executive (CRCE) HFMA
  • Certified Professional Biller (CPB) AAPC
  • Certified Healthcare Financial Professional (CHFP) – HFMA
  • Certified Compliance Officer (CHC) – HCCA

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