Healthcare Revenue Cycle Manager

Healthcare Revenue Cycle Manager ProMedix Health

• 5.0 Santa Ana, CA Job Details Full-time $135,000
• $180,000 a year 17 hours ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance Qualifications Financial close processing Contract management Teamwork Medicare Operations management Accounts receivable management Overseeing healthcare denial management Provider enrollment for medical credentialing CMS Regulatory compliance in claims processing Contract management in healthcare CMS regulatory compliance Medicare regulations Clinical documentation Medical insurance appeals management Organizational skills Contracts Revenue recognition Centers for Medicare & Medicaid Services (CMS) billing regulations Medical claims submission Medical billing account reconciliation Clinical documentation improvement Clinical documentation standards Month-end close Medical claim denial management Audit support Senior leadership Terms and conditions negotiation Full Job Description Director of Revenue Cycle & Compliance Medicare RCM•CPT Billing•Payer Contracting•Multi-State Credentialing•Compliance ProMedix Health • Southern California • On-Site • Full-Time About ProMedix Health ProMedix Health is a Medicare-focused virtual care company based in Southern California, delivering Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and related programs to patients across medical practices, physician groups, and health systems.

We are expanding rapidly across multiple states and payer environments and need a senior revenue cycle leader to own the financial integrity of our billing operations end to end. Location Southern California

• On-site full-time (no remote or hybrid) Employment Type Full-Time, Exempt The Opportunity ProMedix Health is looking for a Director of Revenue Cycle & Compliance who owns the full revenue cycle across our chronic care management programs
• from claims submission and denial management through collections, payer contract negotiations, and multi-state credentialing.

This is a senior leadership role requiring deep Medicare billing expertise, strong compliance knowledge, and the ability to operate across a complex and growing payer environment that includes both fee-for-service and capitated arrangements. This role carries joint accountability with the Controller for ensuring all RCM data is audit-ready at month-end. Deep healthcare industry experience in a Medicare-focused organization is required. Core Responsibilities Revenue Cycle Management Own the end-to-end revenue cycle across all CCM, RPM, and related programs

• from charge capture and claims submission through collections and AR management Ensure all claims are submitted accurately, completely, and on time
• zero tolerance for preventable denials caused by documentation gaps or coding errors Lead denial management
• analyze denial patterns by payer and code, implement corrective actions, and track improvement Oversee medical billing staff
• set performance standards, monitor accuracy, and hold the billing function accountable to defined KPIs Ensure all RCM data is audit-ready at each month-end close
• AR balances reconciled, claim statuses current and documented, and revenue recognition inputs aligned with the Controller's financial reporting requirements Medicare Billing, CPT Coding & Billing Compliance Maintain deep working knowledge of Medicare CCM, RPM, CoCM, TCM, and related billing requirements
• documentation standards, time thresholds, and CMS compliance Ensure CPT coding accuracy across all programs
• identify and correct miscoding, undercoding, and compliance risks Ensure billing and coding compliance with CMS requirements across all programs
• maintain audit-ready documentation standards and work in close collaboration with clinical and legal counsel on broader regulatory compliance matters Stay current on Medicare billing policy changes and CMS guidance
• implement changes proactively Payer Contracting & Relationship Management Lead payer contract negotiations with Medicare Advantage plans, IPAs, and managed care organizations
• including both fee-for-service and capitated arrangements Actively manage the financial implications of capitation versus fee-for-service across the payer mix Develop and maintain productive relationships with key payers
• resolve disputes and reduce denial rates Evaluate and negotiate new payer agreements as the company expands into new markets Multi-State Credentialing & Market Expansion Own Medicare credentialing across all active and target states
• manage the process to support market launch timelines Maintain current credentialing status across all states and all payers
• proactively manage renewals Stay ahead of state-specific Medicare enrollment requirements as new markets are activated Financial Reporting & Collaboration Deliver regular RCM performance reporting to the CEO
• claims, collections, denial rates, AR aging, and reimbursement per enrolled patient by program Work closely with the Controller to ensure RCM data accurately supports financial reporting, revenue recognition, and audit readiness Identify and proactively address operational leakage in the billing and collections process What We Are Looking For Required Minimum 5 years of RCM experience with at least 3 years in a senior role in a Medicare-focused organization Deep expertise in Medicare CCM, RPM, or chronic care management billing•CPT coding, documentation requirements, and CMS compliance standards Demonstrated experience with both fee-for-service and capitated reimbursement arrangements Proven experience negotiating payer contracts with Medicare Advantage plans, IPAs, or managed care organizations Multi-state Medicare credentialing experience across more than one state Strong denial management and AR management track record with measurable results Demonstrated month-end close experience from an RCM perspective•audit-ready AR reconciliations and revenue recognition data delivered to finance on a defined monthly schedule Deep healthcare industry experience required•minimum 5 years in a Medicare-focused organization with direct familiarity with CMS requirements, payer dynamics, and healthcare compliance standards Why ProMedix Own a critical revenue function at a company growing rapidly across multiple markets and programs A complex and intellectually engaging RCM environment spanning multiple payer types, programs, and states Competitive compensation and benefits A mission-driven company improving outcomes for Medicare patients managing chronic conditions Salary Disclaimer•Pay Transparency ProMedix Health offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs.

Our benefits package includes, but is not limited to, paid time off, a 401(k) retirement plan, medical, dental, and vision coverage, and other voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $135,000 to $180,000 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure. To Apply Submit your resume and a brief cover letter describing your Medicare RCM experience

• specifically your background with CCM or RPM billing, payer contracting, and multi-state credentialing.

We review applications on a rolling basis and move quickly for strong candidates. ProMedix Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Pay:

$135,000.00

• $180,000.

00 per year

Work Location:

In person