Oscar
Senior Manager, Revenue Cycle Management, Provider Operations
Atlanta, Georgia, United States. Posted a month ago
The role
The Senior Manager, Revenue Cycle Management leads and optimizes revenue cycle operations across Oscar Medical Group. This person develops scalable strategies for coding, billing, and reimbursement while partnering with clinical, finance, and compliance teams.
What you will do
- Own the strategy and performance of OMG's revenue cycle function
- Serve as the senior subject matter expert for coding and billing
- Establish and monitor revenue cycle KPIs and controls
- Lead coding and documentation integrity strategies
- Lead denial prevention and resolution strategies
- Partner with clinical leadership on ICD-10/HCC documentation and coding
- Evaluate payer-specific performance, requirements, and coding considerations
- Partner cross-functionally with Clinical Operations, Finance, Compliance, Credentialing, Product/Technology, and other stakeholders
- Develop scalable revenue cycle policies, workflows, governance, and vendor oversight
- Advise OMG leadership on revenue cycle performance, financial opportunities, and operational risks
Required qualifications
- 7+ years of progressive experience in healthcare revenue cycle, professional billing, coding, or related healthcare operations
- 3+ years of experience leading revenue cycle programs, teams, or functions with accountability for operational and/or financial outcomes
- Advanced knowledge of professional billing and coding, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, claims management, denial management, and payer requirements
- Experience developing and executing revenue cycle strategies that improve coding accuracy, claims performance, reimbursement, and overall financial outcomes
- Experience with coding and clinical documentation integrity, including provider documentation review, provider queries, and pre- and post-bill review processes
- Demonstrated ability to analyze complex revenue cycle data, identify trends and root causes, and translate findings into actionable strategies and recommendations
- Demonstrated experience leading complex, cross-functional initiatives, partnering with clinical, operations, finance, compliance, credentialing, and other stakeholders to drive results
- Strong executive communication skills
Nice to have
- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician-based (CCS-P), Certified Professional Medical Auditor (CPMA), or comparable coding/revenu
- Experience leading or overseeing coding professionals and/or certified coders
- Experience working within a multi-state medical group, telehealth organization, or other complex healthcare delivery environment
- Experience working within both provider and payer environments
- Experience with risk-adjustment coding, including ICD-10/HCC documentation and coding practices
- Experience with credentialing and payer enrollment processes
- Experience managing external revenue cycle, coding, or billing vendors
Benefits
- Medical, dental, and vision benefits
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life and disability insurance
- Paid wellness time and reimbursements
- Unlimited vacation program
- Annual performance bonuses
About the company
Oscar is a health insurance company built around a full stack technology platform. It was started in 2012 to create a health insurance company that behaves like a doctor in the family.