Summit Medical Management, LLC

Description: The Revenue Cycle Manager (RCM) leads all billing, coding, claims submission, denial management, and accounts receivable functions for Summit Surgical. Operating as both a working manager and a strategic leader, the RCM oversees a team of billing and coding specialists while maintaining direct accountability for the facility's net revenue capture, payer compliance, and financial reporting accuracy. Responsibilities: Revenue Cycle Operations Oversee end-to-end revenue cycle: patient registration, prior authorization, charge capture, coding review, claims submission, payment posting, denial management, and A/R follow-up, payer contract and relationship management, Ensure timely and accurate claim submission to Medicare, Medicaid, and all commercial payers in compliance with CMS and payer-specific guidelines Maintain clean claim rate target of =95% and monitor days in A/R against facility benchmarks Manage and optimize TruBridge billing and coding modules; identify workflow improvement opportunities Maintain charge description master (CDM) integrity and accuracy of payer fee schedules Coding & Compliance Review and audit surgical, anesthesia, and facility coding for accuracy under ICD-10-CM/PCS, CPT, and HCPCS Level II guidelines Maintain HIPAA billing compliance and adhere to OIG compliance program requirements Serve as primary liaison with Summit physicians and clinical staff on clinical documentation improvement and charge capture accuracy Monitor and implement regulatory updates from CMS, OIG, and AAPC Financial Reporting & Analysis Produce weekly, monthly, and quarterly revenue cycle performance dashboards for FenixMed leadership and Summit ownership Track and report key metrics: days in A/R, denial rate, clean claim rate, cash collections, write-off ratios, and net collection rate Lead root-cause analysis on denial trends and underpayments; develop and execute corrective action plans Coordinate with FenixMed accounting team for month-end close, contractual adjustments, and bad debt reserve calculations Team Leadership & Development Recruit, hire, onboard, and develop billing and coding specialists Set individual performance goals, provide regular coaching, and conduct annual performance reviews Create and maintain billing and coding policy and procedure documentation Coordinate continuing education and support certification maintenance for team members Payer & Vendor Relations Manage payer contracts, credentialing timelines, and provider enrollment in coordination with FenixMed Serve as primary escalation contact for complex claim disputes and payer audits Evaluate and recommend billing technology tools, clearinghouses, or supplemental coding resources as needed Requirements: Education: Bachelor's degree in Health Information Management, Business Administration, Healthcare Administration, or related field required Equivalent combination of education and directly related experience may be considered Licensure: No licensure required for this position Certification: Preferred: Active coding or billing certification from AAPC or AHIMA Certified Professional Coder (CPC) - AAPC Certified Outpatient Coder (COC) - AAPC; preferred for surgical/ASC environment Certified Coding Specialist (CCS) - AHIMA Certified Healthcare Financial Professional (CHFP) - HFMA Annual certification maintenance stipend provided ($500-$1,000) Experience: Minimum 5 years of progressive healthcare revenue cycle experience required Minimum 2 years in a supervisory, lead, or management role required Direct experience in a hospital, ambulatory surgery center, or physician-owned surgical facility required Experience with EHR/PM billing modules required; TruBridge (Netsmart) experience strongly preferred Experience managing a transition from outsourced to in-house revenue cycle operations preferred Familiarity with Kansas Medicaid (KanCare) and regional commercial payer requirements preferred Skills: Proficiency with ICD-10-CM/PCS, CPT, HCPCS Level II, and modifier application in surgical settings Working knowledge of Medicare, Medicaid, and major commercial payer billing rules and reimbursement methodologies Strong data analysis skills; ability to build, interpret, and present A/R and denial management reports Proficiency in Microsoft Office Suite (Excel, Word, Outlook, Teams) Excellent written and verbal communication skills; ability to translate financial data for clinical and executive audiences Demonstrated accountability, integrity, and ability to manage competing priorities in a fast-moving environment Work Schedule: Regular schedule is Monday - Friday, 8:00 am to 5:00 pm PIf1c279aa75b9-0841