Remote Payer Rules & RCM Optimization Lead

Cardinal Health; Helena (MT); Remote; USD 89,000 - 114,000; Full time

Benefits offered by this job

Medical, dental, vision

401k plan

Paid time off

Job summary

Cardinal Health is seeking a Manager, Payer Rules & Revenue Cycle Optimization to lead the operational implementation and ongoing maintenance of payer rules across the revenue cycle. You will oversee a team of three FTEs, translate contracts into system rules, and partner with IT, Payer Relations, and Market Access to improve billing accuracy and reduce denials.

You will ensure alignment with payer requirements, automate upstream controls, and drive measurable revenue cycle improvements across

Qualifications

• Bachelor's degree in healthcare administration, business, finance, or IS, or equivalent experience.
• 5+ years in healthcare revenue cycle, payer operations, reimbursement, or payer rules.
• Demonstrated leadership or supervision of staff.
• Strong knowledge of payer contracts and billing requirements.
• Experience coordinating system configurations, change controls, testing, and audits.
• Brightree, InRule, or comparable rules engines.

Responsibilities

• Lead and coach a team of three FTEs; set priorities and ensure timely payer rule implementations.
• Manage readiness for new payer contracts, renewals, and amendments with clear timelines.
• Translate payer contracts and billing guidelines into system rules and SOPs.
• Oversee Brightree and InRule configurations, including coverage, modifiers, eligibility, and edits.
• Coordinate testing, validation, and remediation with IT, vendors, and clearinghouses.
• Establish governance for payer rule changes, including ownership and change logs.
• Monitor payer policy updates and communicate impact to cross-functional teams.
• Collaborate with Payer Relations and Market Access to clarify contract provisions.

Skills

Leadership

Supervision

Analytical

Problem-solving

Payer rules knowledge

Education

Bachelor's degree in healthcare administration

Tools

Brightree

InRule

EDI & Clearinghouses

Job description

Cardinal Health is seeking a Manager, Payer Rules & Revenue Cycle Optimization to lead the operational implementation and ongoing maintenance of payer rules across the revenue cycle. You will oversee a team of three FTEs, translate contracts into system rules, and partner with IT, Payer Relations, and Market Access to improve billing accuracy and reduce denials.

You will ensure alignment with payer requirements, automate upstream controls, and drive measurable revenue cycle improvements across