Sr. Manager, Reimbursement Operations

The Position:

We are seeking a highly skilled and experienced Senior Manager, Reimbursement Operations – Strategic Initiatives to lead high-impact initiatives within the Revenue Cycle Operations. This role will be focused on designing and implementing processes to achieve sustainable operational improvements, drive incremental collections (Reduce denials, increase Claim Overturns by improving appeal efficacy, et al), and ensure the success of key workstreams part of reimbursement operations (e.g., Digital System Transformations, Epic Interoperability, et al). Success in this role requires deep expertise in medical billing systems, fluency in payor medical & claim policies (and their corresponding review processes), a strong understanding of regulatory and compliance aspects of billing in a diagnostic lab setting and proven experience in scaling operations in a revenue cycle environment; strong analytical, interpersonal, and communication skills will be critical to success as well.

• Develop and implement strategic plans to optimize the revenue cycle process, aligning it with organizational goals and industry best practices.
• Design and deliver scalable, system-based solutions by producing clear problem statements, process maps, business requirements, et al to facilitate the implementation of new processes or technologies. 
• Support the optimization of collections by performing root causes analyses on claims performance issues, identifying ways to solve those issues, and partnering with relevant teams to implement and drive to resolution.
• Take a proactive role in evaluating and implementing revenue cycle technologies (OCR, AI-Enabled workflows, integrations, automations, et al.) to enhance operational effectiveness.
• Leverage expertise in Clinical Coding and Documentation to ensure operational systems/processes are built to reduce risk of erroneous billing and optimize reimbursement.
• Serve as Project Lead on Strategic Revenue Cycle Initiatives (technology or other) to ensure the successful implementation and operationalization is achieved.
• Partner with Reimbursement leaders to re‑engineer reimbursement workflow to standardize processes while preserving flexibility for payor‑specific nuances.

Who You Are:

• 8+ years of experience in healthcare reimbursement, revenue cycle operations, or related financial operations, with progressive leadership responsibility. 
• Success in building and lead Revenue Cycle operational teams across various fuctions.
• Demonstrated success driving process improvement and reimbursement optimization initiatives with measurable financial impact. 
• Strong understanding of payor dynamics, prior authorization, claims adjudication, denials, and appeals, with experience participating in conversations with payors on claims or other related issues to achieve resolution. 
• Experience leading or partnering with automation, AI, or technology enabled operational transformations. 
• Advanced analytical skills with the ability to translate complex data into actionable insights. 
• Proven ability to lead cross functional initiatives in a fast paced, ambiguous environment. 
• CPMA/CPC Certifications

 Preferred 

• Clinical Background (BSN, Genetic Counseling)
• Experience in diagnostics, laboratory services, or complex reimbursement environments.
• Formal training or certification in Lean, Six Sigma, or process improvement methodologies

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