RCM Payer Rules Leader: Optimize Revenue Cycle

Cardinal Health; United States; On-site; USD 89,000 - 114,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off plan

Health savings account (HSA)

401k savings plan

Access to wages before pay day with my

Flexible spending accounts (FSAs)

Short- and long-term disability

Job summary

Cardinal Health is seeking a Manager of Payer Rules & Revenue Cycle Optimization to lead a three-person team and drive payer rule implementation across the revenue cycle. You will translate contracts and policies into actionable system rules, coordinate testing, and ensure timely, accurate configurations.

The role partners with IT, payer relations, and operations to improve billing accuracy, prevent denials, and accelerate cash collections, with a salary range and bonus eligibility noted in the

Qualifications

• Bachelor's degree in healthcare administration, business, finance, information systems, or related field, or equivalent relevant experience preferred.
• 5+ years of experience in healthcare revenue cycle, payer operations, reimbursement, billing systems, or payer rules preferred.
• Demonstrated leadership or supervision of staff.
• Strong knowledge of payer contractual and billing requirements, claims processing, denial management, and translating business needs into operational processes and system rules.
• Experience coordinating system configurations, change controls, testing, audits, and cross-functional process improvement; strong analytical, communication, and problem solving skills.

Responsibilities

• Lead, coach, and manage a team of three FTEs; establish priorities, allocate work, monitor quality and productivity, develop team capabilities, and ensure timely completion of payer rule and contract implementation requests.
• Oversee end-to-end operational readiness for new payer contracts, renewals, amendments, and updates to existing agreements, confirming payer requirements are configured, tested, communicated, and ready by applicable effective dates.
• Translate payer contracts, reimbursement policies, and billing guidelines into actionable system rules, business requirements, standard operating procedures, and controls across front-end, mid-cycle, and back-end RCM.
• Own functional accuracy and ongoing maintenance of payer-specific configurations within Brightree and InRule, including coverage and HCPCS requirements, modifiers, eligibility, authorization, documentation, medical necessity, frequency limits, and claim submission edits.
• Partner with IT, system administrators, vendors, and clearinghouses to develop specifications, oversee configuration changes, coordinate user acceptance testing, validate results, and resolve conflicting or ineffective Brightree, InRule, or clearinghouse rules.
• Create a structured governance process for intake, prioritization, approval, documentation, auditing, and ongoing validation of payer rule changes, including ownership, effective dates, change logs, and implementation status.

Skills

Leadership

Healthcare revenue cycle

Payer contract knowledge

Analytical skills

Education

Bachelor's degree in healthcare administration, business, finance, information systems, or related field

Tools

Brightree

InRule

EDI and clearinghouse processes

Job description

Cardinal Health is seeking a Manager of Payer Rules & Revenue Cycle Optimization to lead a three-person team and drive payer rule implementation across the revenue cycle. You will translate contracts and policies into actionable system rules, coordinate testing, and ensure timely, accurate configurations.

The role partners with IT, payer relations, and operations to improve billing accuracy, prevent denials, and accelerate cash collections, with a salary range and bonus eligibility noted in the