Job Description
Position Summary The Revenue Integrity and Access Manager is responsible for supporting the organization's revenue cycle strategy while overseeing revenue related operational functions that directly impact reimbursement, patient access, and financial sustainability. This role ensures the integrity of revenue processes from the front end through reimbursement by collaborating with operational leadership, finance, clinical teams, and external partners.
The Manager oversees operational areas including referrals, community health workers, financial counselors, credentialing, call center, and front end registration functions to ensure accurate patient access, appropriate insurance coverage verification, and timely financial navigation services.
This position works closely with billing vendors, enrollment, credentialing, outreach teams, providers, finance, and operational leadership to improve revenue cycle performance, reduce denials, and strengthen revenue capture. The Manager also supports staff training, reviews departmental denial trends, and implements corrective action plans to optimize reimbursement and maintain regulatory compliance.
The role ensures accurate and timely reimbursement, monitors self pay and denial trends, oversees OSV compliance including sliding scale implementation, and supports ongoing staff education related to registration, insurance verification, scheduling workflows, and financial counseling.
Primary Responsibilities Revenue Integrity Oversight
- Manage and oversee daily revenue integrity operations to maximize reimbursement and ensure regulatory compliance.
- Monitor billing accuracy, denial trends, aging reports, payment variances, claim holds, and credit balances.
- Review departmental denial reports and work with operational leaders to identify root causes and implement corrective actions.
- Analyze payer reimbursement methodologies and escalate payment discrepancies as needed.
- Prepare and review monthly revenue performance reports and provide recommendations to leadership.
- Maintain payer fee schedules and reimbursement grids to ensure accuracy.
Front End Revenue Operations - Provide monthly registration and patient access training for front end staff to ensure proper insurance verification, scheduling workflows, and registration accuracy.
- Ensure front end processes support optimal charge capture and reimbursement.
- Develop and maintain workflows that support efficient patient access and financial clearance.
Operational Oversight - Oversee operational areas that support revenue cycle performance including:
- Referral coordination processes
- Community Health Workers
- Financial counselors and enrollment staff
- Ensure workflows between referrals, financial counseling, and scheduling support accurate revenue capture and patient access.
- Monitor performance metrics across these areas and implement operational improvements.
Revenue Cycle Collaboration - Partner with third party billing vendors and internal teams to resolve reimbursement issues.
- Collaborate with enrollment, credentialing, outreach, and clinical leadership to strengthen revenue related processes.
- Support contract management and maintain relationships with payer representatives.
- Participate in revenue related operational and financial planning discussions.
Compliance and Financial Programs - Ensure OSV compliance and oversight of sliding scale implementation.
- Monitor self pay trends and support financial assistance workflows.
- Ensure revenue related policies and procedures align with regulatory requirements.
Reporting and Analysis - Maintain working knowledge of EMR and billing system reports to identify root causes of revenue leakage.
- Perform cost benefit analyses related to reimbursement optimization.
- Develop dashboards and reports to monitor revenue cycle performance indicators.
Customer Service and Leadership - Provide strong customer service to patients, providers, and internal staff.
- Support leadership in developing operational strategies that improve access, reimbursement, and patient financial navigation.
Qualifications Education and Experience - Bachelor's degree in Business, Healthcare Administration, Finance, or related field required.
- MBA or MHA preferred.
- Minimum of five years of healthcare revenue cycle or revenue operations management experience.
- Experience in FQHC or community based healthcare strongly preferred.
- Experience overseeing patient access, financial counseling, referrals, or revenue operations.
- Experience working with payer contracts, reimbursement methodologies, and denial management.
- Medical practice or ambulatory healthcare setting experience preferred.
Competencies and Attributes - Strong ethical standards and professional integrity.
- Detail oriented with strong organizational and analytical skills.
- Ability to manage multiple operational priorities in a fast paced healthcare environment.
- Strong written and verbal communication skills.
- Ability to work cross functionally with clinical, financial, and operational teams.
- Working knowledge of local, state, and federal healthcare regulations.
- Advanced analytical skills with experience reviewing revenue cycle data.
- Proficiency in Microsoft Office, including Excel and PowerPoint.
- Ability to independently manage projects and meet deadlines.
Physical Requirements - Must be able to stand or sit for prolonged periods (50% of the time)
- Must be able to lift up to 25 pounds and load onto shelves
- Visual acuity sufficient for frequent reading and computer use
Job Tags
Contract work, Work at office, Local area