Remote Payer Rules & RCM Manager

Cardinal Health; Lincoln (NE); A distancia; USD 89.000 - 114.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

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

Descripción de la vacante

Cardinal Health is seeking a Manager, Payer Rules & Revenue Cycle Optimization to lead payer rule implementation and maintain configurations across the revenue cycle. You will manage a three-FTE team and collaborate with Payer Relations, IT, and Operations to improve billing accuracy and reduce denials.

Requires a Bachelor’s degree and 5+ years in healthcare revenue cycle; experience with Brightree and InRule is preferred. This is a country-wide remote role with strong bonus eligibility.

Formación

• Bachelor's degree in healthcare administration, Business, Finance, Information Systems, or 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.
• Experience coordinating system configurations, change controls, testing, audits.
• Brightree, InRule, or comparable rules engines; Medicare, Medicaid, Medicare Advantage and commercial payer requirements; EDI and clearinghouse processes preferred.

Responsabilidades

• Lead and manage a team of three FTEs; establish priorities, allocate work, monitor quality and productivity.
• 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

Conocimientos

Team leadership

Payer rules knowledge

Analytical skills

Communication

Change management

Educación

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

Herramientas

Brightree

InRule

Descripción del empleo

Cardinal Health is seeking a Manager, Payer Rules & Revenue Cycle Optimization to lead payer rule implementation and maintain configurations across the revenue cycle. You will manage a three-FTE team and collaborate with Payer Relations, IT, and Operations to improve billing accuracy and reduce denials.

Requires a Bachelor’s degree and 5+ years in healthcare revenue cycle; experience with Brightree and InRule is preferred. This is a country-wide remote role with strong bonus eligibility.