Remote Payer Rules & RCM Optimization Leader

Cardinal Health; Boise (ID); À distance; USD 89 000 - 114 000; Plein temps

Avantages offerts par ce poste

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)

Disability coverage

Work-Life resources

Paid parental leave

Healthy lifestyle programs

Résumé du poste

Cardinal Health is seeking a Manager, Payer Rules & Revenue Cycle Optimization, to lead a three-person team in nationwide remote operations. You will implement payer rules across Brightree and InRule, optimize contracts, and improve billing accuracy and collections.

You will coordinate with IT, payer relations, and market access to translate contracts and policies into system rules and controls, monitor updates, and drive revenue cycle improvements across the organization.

Qualifications

• Bachelor's degree in healthcare administration, business, finance, information systems, or related field, or equivalent experience.
• 5+ years 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.
• Experience coordinating system configurations, change controls, testing, audits, and cross-functional processes.
• DMEPOS or medical supply reimbursement preferred.
• Brightree, InRule, or comparable rules engines; Medicare/Medicaid/MA and commercial payer requirements; EDI and clearinghouse processes preferred.

Responsabilités

• Lead, coach, and manage a team of three FTEs; set priorities, allocate work, monitor quality and productivity.
• Oversee readiness for new payer contracts, renewals, amendments, and updates to existing agreements.
• Translate payer contracts, policies, and guidelines into actionable system rules and procedures.
• Own configurations within Brightree and InRule, including coverage, modifiers, eligibility, and claim edits.
• Coordinate with IT, vendors, and clearinghouses to test, validate, and implement rule changes.
• Create governance for intake, prioritization, approval, and documentation of payer rule changes.
• Monitor payer policy updates and communicate requirements across teams.
• Analyze denials and variances to identify gaps and remediation opportunities.
• Implement upstream controls to reduce denials and improve cash collection.
• Develop metrics and report progress on rule implementation and revenue cycle improvements.
• Ensure compliance with guidelines and departmental operations.

Connaissances

Leadership

Analytical skills

Communication

Problem-solving

Team management

Formation

Bachelor's degree in healthcare admin/Business/Finance/IS

Outils

Brightree

InRule

EDI/clearinghouse

Description du poste

Cardinal Health is seeking a Manager, Payer Rules & Revenue Cycle Optimization, to lead a three-person team in nationwide remote operations. You will implement payer rules across Brightree and InRule, optimize contracts, and improve billing accuracy and collections.

You will coordinate with IT, payer relations, and market access to translate contracts and policies into system rules and controls, monitor updates, and drive revenue cycle improvements across the organization.