Remote Payer Rules & RCM Optimization Manager

Cardinal Health; Phoenix (AZ); Remote; USD 89,000 - 114,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Health savings account (HSA)

401k savings plan

Flexible spending accounts (FSAs)

Paid parental leave

Job summary

Cardinal Health is seeking a Manager, Payer Rules & Revenue Cycle Optimization to lead the operational implementation of payer rules across the revenue cycle. You will oversee a trio of FTEs and collaborate with Payer Relations, Market Access, IT, and business transformation to drive accuracy, prevent denials, and accelerate collections.

The role emphasizes governance of payer rule changes, enterprise standardization, and metrics on contract implementation timeliness and denials trends.

Qualifications

• Bachelor's degree in healthcare administration, business, finance, information systems, or related field.
• 5+ years in healthcare revenue cycle, payer operations, reimbursement, billing systems, or payer rules.
• Experience leading staff and cross-functional teams.
• Strong knowledge of payer contracts, billing requirements, denials, and translating needs into rules.

Responsibilities

• Lead and manage a team of three FTEs; set priorities, assign work, monitor quality and productivity.
• Oversee readiness for new payer contracts, renewals, and amendments with timely configurations.
• Translate payer contracts and policies into actionable system rules and SOPs across the RCM lifecycle.
• Maintain payer-specific configurations in Brightree and InRule with emphasis on coverage, HCPCS, eligibility, and authorizations.
• Collaborate with IT, vendors, and clearinghouses to specify changes, test, and validate outcomes.

Skills

Leadership

Analytical

Communication

Problem-solving

Healthcare knowledge

Education

Bachelor's degree in healthcare administration or related field

Tools

Brightree

InRule

EDI / clearinghouses

Job description

Cardinal Health is seeking a Manager, Payer Rules & Revenue Cycle Optimization to lead the operational implementation of payer rules across the revenue cycle. You will oversee a trio of FTEs and collaborate with Payer Relations, Market Access, IT, and business transformation to drive accuracy, prevent denials, and accelerate collections.

The role emphasizes governance of payer rule changes, enterprise standardization, and metrics on contract implementation timeliness and denials trends.