RCM Manager

We are seeking an experienced and strategic RCM Manager with hands-on expertise in Candid Health software to oversee end-to-end medical billing operations, claim processing, and denial resolution workflows. In this role, you will lead the revenue cycle team, leveraging Candid Health's modern platform to optimize claim submissions, troubleshoot payer rejections, and maximize net collections for our healthcare operations.

Responsibilities:

• Claim Operations and Execution: Oversee daily claim generation, scrubbing, electronic submission, and electronic remittance advice (ERA) posting utilizing the Candid Health platform.
• Denials and Appeals Management: Conduct root-cause analysis on denied and rejected claims; lead strategies to compose, submit, and track effective administrative and clinical appeals through Candid Health and payer portals.
• Accounts Receivable (A/R) Tracking: Monitor aged accounts receivable (30/60/90+ days), identify resolution barriers, and direct team interactions with commercial and government payers for expedited reimbursement.
• Patient Billing and Eligibility Oversight: Supervise pre-service insurance eligibility checks, authorization requirements, and accurate patient balance billing to ensure clean claim flow.
• Financial Reporting and Team Leadership: Track key performance indicators (clean claim rate, days in A/R, denial rates), perform monthly reconciliation against bank deposits, and manage billing team performance.

Requirements:

• Direct System Experience: Proven leadership experience in US healthcare revenue cycle management, with mandatory, hands-on proficiency in Candid Health billing software.
• Payer and Billing Knowledge: Deep understanding of US healthcare reimbursement models, Medicare/Medicaid regulations, private commercial insurance policies, and CMS-1500 claim guidelines.
• Medical Coding Standards: Solid knowledge of standard medical code sets (ICD-10-CM, CPT, HCPCS) and clinical documentation requirements.
• Technical and Analytical Aptitude: Strong proficiency in data analysis using Microsoft Excel (Pivot tables, VLOOKUP/XLOOKUP) to isolate and rectify systemic billing errors.