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Salary: USD 122,212 - 160,404 / annual
Oscar Health is seeking a Senior Manager, Revenue Cycle Management to lead and optimize revenue cycle operations across Oscar Medical Group (OMG). This role owns the development and execution of scalable revenue cycle strategies and processes that support accurate coding, compliant billing, timely reimbursement, and overall financial performance.
The Senior Manager will serve as a subject matter expert in professional billing and coding, partnering closely with clinical, operations, finance, compliance, credentialing, and product teams to identify revenue cycle risks and opportunities and translate them into actionable operational strategies. You will establish performance standards, controls, reporting, and workflows across the revenue cycle while using data and root-cause analysis to drive measurable improvements in revenue capture, claims performance, coding accuracy, and provider documentation. You will also provide strategic guidance to OMG leadership on revenue cycle performance, risks, and opportunities as the organization grows.
Key responsibilities include owning the strategy and performance of OMG's revenue cycle function (professional billing, coding, claims management, denials, eligibility, documentation); serving as senior subject matter expert for coding and billing (CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, payer requirements); establishing and monitoring revenue cycle KPIs and controls; leading coding and documentation integrity strategies including pre- and post-bill review, provider queries, and provider education; leading denial prevention and resolution strategies; partnering with clinical leadership on ICD-10/HCC documentation; evaluating payer-specific performance and developing strategies to address reimbursement and claim issues; partnering cross-functionally to resolve complex revenue cycle issues; developing scalable policies, workflows, and governance; and advising leadership on revenue cycle performance and financial opportunities.
The position is based in Tempe, AZ, requiring a hybrid work schedule with 3 days in-office per week. Thursdays are a required in-office day for team meetings and events, with the other two office days flexible. You will report to the Director, Clinical Operations.
REQUIREMENTS:
- 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
- Strong executive communication skills, with ability to clearly communicate complex revenue cycle performance, risks, opportunities, and recommendations to senior leadership
BONUS QUALIFICATIONS:
- Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician-based (CCS-P), Certified Professional Medical Auditor (CPMA), or comparable coding/revenue cycle certification
- 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 and their downstream impact on revenue cycle performance
- Experience managing external revenue cycle, coding, or billing vendors
