Remote Lead, Payer Rules & RCM Optimization

Cardinal Health; Pierre (SD); Remote; 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

Work-Life resources

Paid parental leave

Healthy lifestyle programs

Job summary

Cardinal Health is seeking a Manager of Payer Rules & Revenue Cycle Optimization to lead the operational implementation of payer rules across the revenue cycle. You will oversee a three-FTE team and ensure new and updated payer contracts are translated into actionable workflows and system configurations.

You will collaborate with Payer Relations, Market Access, IT, and others to improve billing accuracy, reduce denials, and accelerate cash collections, while maintaining governance and

Qualifications

• Bachelor's degree or equivalent in a related field.
• 5+ years of experience in healthcare revenue cycle, payer operations, reimbursement, billing systems, or payer rules.
• Demonstrated leadership or supervision of staff.
• Strong knowledge of payer contractual and billing requirements, claims processing, denial management, and translating needs into operational rules.
• Experience coordinating system configurations, change controls, testing, audits, and cross-functional process improvement.

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.
• Proactively monitor Medicare, Medicaid, Medicare Advantage, commercial payer, and manufacturer policy updates; assess impact and communicate requirements to Payer Relations, Customer Operations, Sales, Order Processing, and RCM teams.
• Partner with Payer Relations and Market Access to clarify contract provisions and investigate differences between contracted requirements, system configuration, and actual payer adjudication or reimbursement.
• Analyze payer denials, clearinghouse rejections, unbilled claims, underpayments, and reimbursement variances to identify systemic configuration or process gaps; prioritize remediation by financial and operational impact.
• Implement upstream, automated controls and payer-specific pre-bill edits to reduce manual work, avoidable denials, revenue leakage, and delayed cash collections.
• Coordinate cross-functional readiness, testing, training, and communication for payer rule changes; elevate risks and ensure accountable owners close identified gaps.
• Support Brightree transformation, integrations, and enterprise standardization efforts while accommodating legitimate payer, product, and business-specific requirements.
• Develop actionable metrics and report progress on contract implementation timeliness, configuration accuracy, rule-related denial trends, change request backlog, and measurable revenue cycle improvements.
• Direct oversight of policies and procedures execution
• Ensure Payer Rules FTEs operate within guidelines and remain compliant

Skills

Leadership

Strategic planning

Analytical thinking

Communication

Education

Bachelor's degree in healthcare administration, Business, Finance, Information Systems, or related field

Tools

Brightree

InRule

EDI / Clearinghouses

Job description

Cardinal Health is seeking a Manager of Payer Rules & Revenue Cycle Optimization to lead the operational implementation of payer rules across the revenue cycle. You will oversee a three-FTE team and ensure new and updated payer contracts are translated into actionable workflows and system configurations.

You will collaborate with Payer Relations, Market Access, IT, and others to improve billing accuracy, reduce denials, and accelerate cash collections, while maintaining governance and