RCM Operations Manager (Billing + Credentialing Manager)
20 days ago
Las Vegas
Job DescriptionDescription: JOB TITLE: RCM Operations Manager (Billing + Credentialing Manager) JOB SUMMARY We are seeking an experienced RCM Operations Manager (Billing + Credentialing Manager) to oversee and optimize our end-to-end revenue cycle operations, including medical billing, claims management, denials/rejections, payment posting, patient balances, provider credentialing, and payer enrollment. This role is responsible for driving revenue performance, ensuring regulatory compliance, maintaining accurate payer relationships, and leading a team to meet productivity and financial targets. The ideal candidate is highly organized, detail-driven, proactive, and comfortable building workflows, managing KPIs, and solving complex payer issues. KEY RESPONSIBILITIES Revenue Cycle Management (Billing & Collections) • Oversee daily operations of billing, claims submission, claim edits, and follow-up., • Monitor and improve clean claim rate, reduce rejections, and ensure timely submission of claims., • Manage denial and rejection workflows, including appeals, corrected claims, and payer disputes., • Ensure accurate payment posting, adjustments, and reconciliation to EOBs/ERAs., • Oversee patient billing and collections processes (statements, follow-up, payment plans if applicable)., • Collaborate with clinical/front office teams to ensure documentation supports billing requirements. Credentialing & Payer Enrollment • Lead provider credentialing and re-credentialing for all payers (Medicare, Medicaid, commercial, networks)., • Manage CAQH profiles, payer applications, EFT/ERA setup, contract participation status, and provider demographic updates., • Maintain credentialing calendar and ensure renewals are completed prior to expiration., • Resolve payer enrollment delays and provide regular progress updates to leadership. Compliance & Risk Management • Ensure compliance with payer guidelines, billing regulations, HIPAA requirements, and internal policies., • Support audits (internal/external), correct process issues, and implement corrective action plans., • Maintain accurate documentation, tracking logs, and workflow SOPs. Team Leadership & Performance Management • Supervise billing and credentialing staff (or coordinate vendors) and ensure productivity goals are met., • Train team members on workflows, payer rules, documentation requirements, and system processes., • Assign workload, evaluate performance, coach staff, and participate in hiring decisions., • Create and enforce standardized processes to reduce errors and improve turnaround times. Reporting & KPI Management • Track and report key performance indicators (KPIs), including:, • Days in A/R, • Denial rate and denial categories, • Net collection rate / gross collection rate, • First-pass acceptance / clean claim rate, • Charge lag and billing lag, • Credentialing turnaround time, • Prepare weekly/monthly RCM reports and recommend improvements based on data., • Identify revenue leakage and implement strategies to improve cash flow. System Optimization & Process Improvement • Optimize billing system/EHR workflows, payer portals, clearinghouse settings, and automation tools., • Develop standard operating procedures (SOPs), checklists, and internal controls., • 3–5+ years of RCM experience in healthcare billing and revenue cycle operations., • 2+ years managing credentialing and payer enrollment processes., • Proven experience managing staff or vendors in an RCM environment., • Strong working knowledge of:, • Claims submission workflows (electronic and corrected claims), • Denials management and appeals, • Eligibility verification, benefits, and authorizations (preferred), • Medicare/Medicaid/commercial payer requirements, • EFT/ERA setup and payer portal management, • Familiarity with EHR/PM systems and clearinghouses., • Strong organizational skills, attention to detail, and ability to meet deadlines. PREFERRED QUALIFICATIONS • Experience in home health, home care, DME, behavioral health, primary care, or multi-specialty clinics., • Knowledge of CPT/ICD-10/HCPCS, modifiers, and medical necessity guidelines., • Experience with Medicare/Medicaid revalidations and enrollment requirements., • Certifications preferred: CPB, CPC, CBCS, or credentialing certification., • Advanced Excel and reporting skills. SKILLS & COMPETENCIES • Strong leadership, accountability, and problem-solving mindset, • Excellent written and verbal communication, • Ability to build workflows and enforce compliance, • Comfortable working in fast-paced environments with multiple priorities, • High attention to detail and strong analytical decision-making, • Strong payer negotiation and follow-up skills WHAT SUCCESS LOOKS LIKE IN THIS ROLE • Clean claims submitted on time, with reduced rejections and denials, • Lower A/R days and stronger collections performance, • Credentialing and payer enrollments completed efficiently with proactive follow-up, • Accurate reporting and clear visibility into revenue performance, • A trained, efficient RCM team with structured workflows and SOPs
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