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Revenue Cycle Manager
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Excel Health
Honolulu, HI (In Person)
$82,000 Salary, Full-Time
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Job Description
Revenue Cycle Manager Excel Health - 3.7 Honolulu, HI Job Details Full-time From $82,000 a year 15 hours ago Benefits Paid holidays Health insurance Dental insurance 401(k) Paid time off Vision insurance Qualifications Microsoft Excel Medicare Team leadership Financial analysis Certified Professional Coder Supervising experience Centers for Medicare and Medicaid Services (CMS) Medical Billing Certification Full Job Description Position Summary We are seeking an elite, highly analytical Revenue Cycle Management (RCM) Manager to oversee the end-to-end billing, coding, and collections operations for both our clinical practice (Excel Neurosurgery & Spine) and our ambulatory surgery center (Honolulu Spine Center). This is a high-level leadership role requiring deep expertise in both professional fee (CMS-1500) and facility fee (UB-04) billing. You will be responsible for maximizing revenue realization, aggressively reducing days in A/R, managing complex prior authorizations for spine and pain procedures, and navigating the specific challenges of the Hawaii payer market (HMSA, Workers' Comp, UHA, HMAA). Key Responsibilities Dual-Entity RCM Oversight Direct the complete revenue cycle for two distinct entities, ensuring seamless workflows between the clinic's professional billing and the ASC's facility billing. Oversee charge capture, coding accuracy, claim submission, payment posting, and statement generation. Ensure accurate billing for high-dollar surgical implants and hardware, maximizing carve-out reimbursements based on facility contracts. Denials Management & A/R Resolution Proactively monitor aging reports and aggressively manage A/R > 90 days to maintain healthy cash flow. Investigate, appeal, and resolve complex claim denials, particularly those related to medical necessity, prior authorization discrepancies, or out-of-network processing. Identify root causes of front-end and back-end denials and implement workflow corrections to improve the clean claim rate. Prior Authorization & Coding Compliance Oversee the authorization team to ensure comprehensive approvals are secured for all complex and endoscopic spine surgeries, interventional pain procedures, and neuromodulation devices (e.g., spinal cord stimulators, PNS). Conduct regular chart audits to ensure physicians are capturing maximum RVUs while maintaining strict compliance with state and federal billing regulations (Stark, Anti-Kickback, OIG guidelines). Educate clinical staff and surgeons on documentation improvements and coding updates (CPT, ICD-10, HCPCS). Leadership & Analytics Lead, train, and mentor a team of medical billers, coders, and authorization specialists. Generate weekly and monthly financial KPI reports (Net Collection Rate, Days in A/R, Denial Rate) to present to the executive team and physician partners. Act as the primary liaison between the practice and external payer representatives to resolve systemic payment issues or contract disputes.