Lead PET/CT Revenue Cycle Management (49499)

Lead PET/CT Revenue Cycle Management (49499) Flourish Imaging - Gainesville, GA 30501 Apply Overview Position Type Full Time Category Health Care Apply Description Company Lead - PET/CT Revenue Cycle Management Position Overview The Company Lead of PET/CT Revenue Cycle Management is responsible for the end-to-end financial and operational performance of the revenue cycle for a rapidly expanding network of PET imaging centers. This role will serve as the central architect of reimbursement strategy, ensuring successful payer enrollment, optimized contracting, and disciplined execution across all front-end and back-end revenue cycle functions. This individual will play a critical role in supporting the organization's national expansion strategy, with an initial rollout of four PET centers and significant projected growth in 2026-2027. Given the high-cost nature of PET radiopharmaceuticals and advanced imaging services, this role is directly accountable for securing accurate, timely, and compliant reimbursement. 1. Payer Enrollment & Credentialing Leadership Lead all aspects of payer enrollment for new PET/CT sites, including CMS enrollment, site readiness coordination, survey management, and PTAN acquisition. Develop scalable workflows aligned with multi-state expansion and ensure enrollment timelines support operational go-live readiness. 2. Commercial Payer Contracting & Strategy Lead commercial payer enrollment and contract negotiations. Optimize reimbursement for PET/CT procedures and radiopharmaceuticals. Develop payer-specific strategies including fee schedule optimization and network positioning. 3. Radiopharmaceutical Reimbursement Optimization Ensure coverage and reimbursement for high-cost PET radiopharmaceuticals. Monitor payer policies and align clinical, operational, and billing practices to minimize financial exposure and maximize reimbursement. 4. Front-End Revenue Cycle Controls Establish best practices for scheduling, insurance verification, and authorization. Ensure accurate intake and reduce preventable denials through strong front-end discipline. 5. Coding, Compliance & Medical Necessity Ensure coding accuracy and alignment with CPT/HCPCS and ICD-10 standards. Maintain compliance with NCD/LCD guidelines and implement audit processes to validate medical necessity. 6. Billing, Collections & AR Performance Oversee charge capture, claims submission, denial management, and AR follow-up. Drive performance against KPIs including Days in AR, denial rates, and net collections. 7. Analytics, Reporting & Continuous Improvement Develop reporting frameworks for reimbursement, denials, and payer performance. Partner with leadership on forecasting and drive continuous process improvement. 8. Cross-Functional Leadership Collaborate across clinical, operations, finance, and external partners. Serve as subject matter expert on PET reimbursement strategy and execution.

Qualifications Required:

• 7-10+ years of healthcare revenue cycle experience
• Experience in diagnostic imaging or radiology
• Expertise in CMS enrollment and payer contracting

Preferred:

• PET/CT and radiopharmaceutical reimbursement experience
• Multi-site healthcare expansion experience
• Knowledge of advanced imaging coding and payer policies Core Competencies
• Strategic thinker with strong execution discipline
• Deep payer and reimbursement expertise
• Analytical and data-driven mindset
• Strong negotiation skills
• Ability to scale in high-growth environments Success Metrics (First 90, 180, 360 days)
• CMS enrollment and PTAN issuance for all sites
• Commercial payer contracts executed
• 95% clean claim rate
• Reduced denial rates
• Improved AR performance and cash flow Why This Role Matters This is a mission-critical role directly tied to the financial viability of a high-cost, high-growth PET imaging service line.

This leader ensures full reimbursement capture while minimizing financial risk and enabling scalable growth.