Revenue Cycle Manager

Department: Revenue Cycle Management
Reports To: Director of Revenue Cycle Management
FLSA Classification: Exempt
Employment Status: Full-Time

Position Summary

The Revenue Cycle Manager is responsible for overseeing and optimizing the organization's entire revenue cycle process, from patient registration and treatment plan financial coordination through insurance billing, payment posting, accounts receivable management, and collections.

This position ensures accurate and timely claim submission, effective insurance follow-up, appropriate patient billing, and consistent collection practices. The Revenue Cycle Manager develops and implements processes that maximize reimbursement, minimize outstanding accounts receivable, reduce claim denials, and improve the overall financial performance of the organization.

The ideal candidate has extensive experience in dental insurance billing, revenue cycle operations, dental practice management systems, and team leadership, with a strong understanding of dental insurance plans, coding, and reimbursement practices.

Essential Duties and Responsibilities

1. Revenue Cycle Management

• Oversee the complete revenue cycle process, including patient financial coordination, claim submission, payment posting, insurance follow-up, patient billing, and collections.
• Establish standardized billing and collection procedures across all dental practices.
• Monitor revenue cycle performance and identify opportunities to improve efficiency and reimbursement.
• Ensure timely and accurate processing of insurance claims and patient accounts.
• Develop procedures to minimize revenue leakage, billing errors, and uncollected balances.
• Collaborate with practice managers and clinical teams to address revenue cycle challenges.

2. Insurance Billing and Claims Management

• Oversee accurate and timely submission of dental insurance claims.
• Ensure appropriate use of CDT codes, narratives, supporting documentation, and attachments.
• Monitor claim rejections, denials, and requests for additional information.
• Establish effective insurance verification and benefit coordination processes.
• Oversee coordination of benefits, pre-authorizations, predeterminations, and appeals.
• Identify recurring denial trends and implement corrective action plans.
• Maintain knowledge of insurance carrier requirements, reimbursement policies, and industry changes.

3. Accounts Receivable and Collections

• Monitor and manage accounts receivable across all locations.
• Establish and maintain appropriate aging benchmarks and collection goals.
• Oversee insurance and patient account follow-up.
• Develop strategies to reduce outstanding balances and improve collection percentages.
• Review accounts with significant outstanding balances and ensure appropriate resolution.
• Monitor unapplied credits, outstanding insurance payments, and credit balances.
• Establish consistent patient collection procedures while maintaining a positive patient experience.
• Escalate unresolved collection issues as appropriate.

4. Payment Posting and Reconciliation

• Oversee accurate posting of insurance payments, patient payments, adjustments, and contractual write-offs.
• Ensure appropriate reconciliation of electronic remittance advice (ERA), electronic funds transfers (EFT), and paper explanations of benefits (EOBs).
• Monitor payment discrepancies, underpayments, and inappropriate adjustments.
• Ensure appropriate controls are in place for refunds, credit balances, and account adjustments.
• Coordinate with the accounting department to reconcile revenue cycle activity and financial reporting.

5. Team Leadership and Development

• Recruit, train, supervise, and develop revenue cycle team members.
• Establish clear job responsibilities, productivity expectations, and performance standards.
• Conduct regular performance evaluations and provide ongoing coaching.
• Monitor individual and departmental productivity.
• Develop training programs to ensure consistent billing and collection practices.
• Promote accountability, teamwork, and continuous improvement.
• Identify staffing needs and establish appropriate departmental coverage.

6. Reporting and Performance Management

• Develop and maintain revenue cycle dashboards and performance reports.
• Monitor key performance indicators (KPIs), including:
  • Net collection percentage.
  • Days in accounts receivable.
  • Accounts receivable aging.
  • Percentage of A/R over 90 days.
  • Insurance claim denial rate.
  • First-pass claim acceptance rate.
  • Average days to submit claims.
  • Patient collection percentage.
  • Unapplied cash and credit balances.
• Provide regular reporting and recommendations to executive leadership.
• Identify financial trends, operational concerns, and opportunities for improvement.
• Establish departmental goals and action plans to achieve organizational financial objectives.

7. Compliance and Internal Controls

• Ensure compliance with applicable federal and state regulations, HIPAA requirements, and dental insurance billing guidelines.
• Maintain confidentiality and security of patient financial and protected health information.
• Establish appropriate controls over billing adjustments, refunds, write-offs, and account access.
• Ensure accurate documentation of account activity and collection efforts.
• Monitor compliance with organizational policies and procedures.
• Support internal and external audits as needed.

8. Process Improvement and Systems Management

• Evaluate existing revenue cycle workflows and recommend process improvements.
• Establish standardized procedures across all locations.
• Work with IT and software vendors to optimize dental practice management systems.
• Identify opportunities to automate billing, payment posting, insurance follow-up, and patient statements.
• Monitor system functionality and resolve operational issues.
• Maintain current knowledge of dental billing practices, insurance requirements, and revenue cycle technology.

Education and Experience

• High school diploma or equivalent required.
• Associate's or bachelor's degree in healthcare administration, business administration, accounting, or a related field preferred.
• Minimum of 5 years of experience in dental billing, insurance claims, accounts receivable, or revenue cycle management.
• Minimum of 2 years of supervisory or management experience preferred.
• Experience managing revenue cycle operations for multiple dental offices preferred.
• Strong knowledge of dental insurance, CDT coding, claims processing, and reimbursement practices.
• Experience with dental practice management software and electronic billing platforms, preferably Carestack, DSN and/or Cloud 9.

Knowledge, Skills, and Abilities

• Strong understanding of dental insurance billing and reimbursement.
• Excellent analytical, problem-solving, and organizational skills.
• Ability to interpret financial reports and identify revenue cycle trends.
• Strong leadership, coaching, and team development skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities and meet deadlines.
• Strong attention to detail and commitment to accuracy.
• Proficiency in Microsoft Excel, reporting tools, and dental practice management systems.
• Ability to develop and implement effective policies, procedures, and workflows.

Performance Expectations

The Revenue Cycle Manager will be evaluated based on the following performance areas:

• Accounts Receivable Management: Achievement of established A/R aging and outstanding balance reduction goals.
• Collection Performance: Achievement of established net collection percentage and patient collection goals.
• Claims Management: Timely submission, accurate processing, and reduction of claim denials.
• Operational Efficiency: Consistent implementation and adherence to standardized revenue cycle procedures.
• Team Performance: Effective supervision, employee development, productivity, and accountability.
• Financial Accuracy: Accurate payment posting, adjustments, reconciliations, and reporting.
• Compliance: Adherence to applicable regulations, insurance requirements, and organizational policies.
• Continuous Improvement: Identification and implementation of initiatives that improve revenue cycle performance.

Working Relationships

The Revenue Cycle Manager works closely with:

• Director of Finance
• Director of Operations
• Regional and Practice Managers
• Front Office and Patient Treatment/Financial Coordinators
• Insurance Billing and Collections Team
• Clinical Leadership
• External Insurance Carriers and Billing Vendors

Physical Requirements and Work Environment

• Primarily office-based work environment.
• Ability to work for extended periods at a computer.
• Frequent use of telephone, email, and electronic communication systems.
• Ability to participate in meetings and communicate effectively with multiple departments and locations.