Senior Manager, RCM Optimization & Strategy

Responsibilities:

• Analyze end-to-end RCM workflows, from pre-billing through denial resolution and patient collections, to eliminate manual processes, remove operational bottlenecks, and address revenue leakage. Design, test, and implement streamlined workflows in partnership with the Senior Director of RCM.
• Own billing system setup and configuration across InStride’s RCM platforms (Apero, Sigma, and Mahler), including payor billing logic, fee schedules, and contract terms, to minimize revenue leakage and maximize contract yield.
• Build, maintain, and continuously refine RCM KPI dashboards (such as clean claim rate, denial rate, days in AR, claim lag, appeals, and collection rate) and share insights with the Senior Director of RCM and the team.
• Perform routine audits of billing engine rules, rule logic, and fee schedules to ensure ongoing compliance with payor guidelines and coding updates.
• Lead deep-dive root-cause analyses on claim denials and underpayments, and recommend durable fixes to the Senior Director of RCM and partner teams.
• Serve as the internal checkpoint for claims escalations raised by the billing and AR team: confirm that internal options (such as credentialing and member eligibility checks) and appeal pathways have been exhausted, and that escalation files are complete (such as member ID), before issues go to the payor.
• Partner with Technology teams to implement automation that streamlines claim submission, denials management, and revenue capture.
• Partner with Payor Operations on systemic payor issues related to claim submission and resolution, including issues that require escalation to health plans.
• Manage internal and clearinghouse configuration rules to resolve pre-claim edits and front-end rejections upstream.
• Lead recurring coordination with Licensing & Credentialing on downstream claims issues and with Authorization & Eligibility on eligibility-driven claim errors (such as an incorrect billable payor), and partner with Patient Access and Clinical Operations to reduce intake-driven denials.
• Lead change management when deploying new billing tools, software integrations, or workflow changes, partnering with the Senior Director of RCM to train and support the team.
• Deliver executive-level RCM insights, progress updates, and financial performance reporting to the Senior Director of RCM and executive leadership.

What You Need to Succeed in the Role

• 6+ years of progressive healthcare revenue cycle management experience, with at least 3 years in an analytical, optimization, or process improvement capacity.
• Bachelor’s degree in Healthcare Administration, Finance, Business Analytics, or a related field or 10+ years in healthcare RCM.
• Proven track record of using complex data sets to streamline RCM operations, reduce claim denials, and recover lost revenue.
• Strong project management background with demonstrated success leading cross-functional tech or process improvement projects.
• Exceptional analytical and problem-solving skills with high attention to detail.
• Clear written and verbal communication skills, with an ability to translate complex revenue cycle data into clear, actionable insights for diverse teams.
• Highly collaborative mindset with proven ability to build effective relationships across clinical, operational, and technical leadership.
• Working knowledge of insurance payor policies, billing guidelines, and claims submission requirements.
• Familiarity with CPT and ICD-10 codes and how they impact billing and reimbursement.
• Hands-on experience with payor contract analysis, fee schedule audits, and underpayment identification and recovery.
• Experience configuring billing platforms; experience with Apero, Sigma, Mahler, or similar RCM software preferred.

Additional Preferred Qualifications

• Behavioral health or telehealth billing background.
• Previous experience in a fast-paced, high-growth, or startup healthcare environment.
• Hands-on experience building custom clearinghouse rules and robotic process automation (RPA)/AI solutions.
• Advanced technical mastery in SQL, BI reporting platforms (e.g., Looker, Power BI), EHR/PM systems, and clearinghouse rule builders.
• Passion for pediatric mental health and expanding access to high-quality care.