Revenue Cycle Manager

Entertimeonline; Fayetteville (NC); On-site; USD 90,000 - 130,000; Full time

Job summary

Valleygate Holdings is seeking a Revenue Cycle Manager in Fayetteville, NC to oversee the full revenue cycle for its ambulatory surgery centers. You will manage verification, coding, billing, collections, and denials while leading contract negotiations with commercial payers and Medicaid plans.

You will report to the COO and collaborate with center administrators, business office staff, and physician partners.

Qualifications

• Bachelor's degree or equivalent experience in healthcare/admin/finance.
• 5+ years of healthcare revenue cycle experience, with 2+ in leadership.
• Direct experience negotiating or administering managed care contracts.
• Strong knowledge of ASC/outpatient billing, CPT/HCPCS, Medicare ASC payment system, modifiers.
• Advanced Excel and financial modeling skills.
• Confident negotiator and clear communicator with payers, physicians, and executives.

Responsibilities

• Oversee revenue cycle functions across centers: verification, coding, billing, collections, and denials.
• Lead managed care contracting with commercial payers, Medicaid plans, and other third parties.
• Maintain central payer contract repository and ensure terms and renewal dates are tracked.
• Audit payments against contract terms and recover underpayments.
• Explain contract terms to center leadership and staff.

Skills

Advanced Excel

Financial modeling

Negotiation skills

Communication with payers

Leadership

Education

Bachelor's degree in healthcare administration, business, finance, or a related field

Tools

HST

SIS

AdvantX

Job description

• Location 2008 Litho Place,Fayetteville, NC, 28305,United States
• Employee Type Exempt Full Time

DescriptionValleygate Holdings owns and operates six ambulatory surgery centers across NC and SC, partnering with physicians to deliver high-quality, cost-effective outpatient surgical care. We're growing, and we need a revenue cycle leader who understands both sides of ASC reimbursement: getting claims paid and negotiating the contracts that decide what we're paid.

As Revenue Cycle Manager, you'll oversee the full revenue cycle for our centers, from scheduling and verification through coding, billing, collections, and denials. You'll also lead managed care contracting, negotiating and administering agreements with commercial payers, Medicaid plans, and other third parties. You'll report to the COO and work closely with center administrators, business office staff, and physician partners.

Duties:

Revenue Cycle Management

• Oversee all revenue cycle functions across our centers: insurance verification, prior authorization, charge capture, coding, claims submission, payment posting, collections, and denial management
• Monitor and report key performance indicators, including days in A/R, clean claim rate, denial rate, net collection rate, and cash collections against targets
• Find the root causes of denials and underpayments, and fix them with process changes, staff training, and payer escalation
• Lead, train, and develop business office staff or manage the relationship with an outsourced billing partner
• Keep billing and coding practices compliant with CMS, ASC payment rules, HIPAA, and payer requirements
• Support new center openings and acquisitions with revenue cycle setup, credentialing coordination, and payer enrollment

Contract Negotiation

• Lead negotiations with commercial payers, Medicaid MCO plans, workers' compensation carriers, and other third-party payers for new agreements and renewals
• Model proposed rates and reimbursement methodologies (percentage of Medicare, case rates, fee schedules, carve-outs, implant reimbursement) to assess financial impact before signing
• Build the case for rate increases using case mix, volume, quality data, and market benchmarks
• Evaluate and recommend decisions on network participation, out-of-network strategy, and new payer opportunities

Contract Administration

• Maintain a central repository of payer contracts, amendments, fee schedules, and key terms, including renewal dates, notice periods, and timely filing limits
• Make sure contracted rates are loaded correctly in the practice management system and audit payments against contract termsIdentify and recover underpayments, and elevate disputes through payer representatives and formal appeal processes
• Track contract deadlines so no renewal or termination window is missed
• Serve as the main point of contact for payer relations and explain contract terms to center leadership and staff

Requirements

Required

• Bachelor's degree in healthcare administration, business, finance, or a related field, or equivalent experience
• 5+ years of healthcare revenue cycle experience, with at least 2 in a leadership role
• Direct experience negotiating or administering managed care contracts
• Strong knowledge of ASC or outpatient surgical billing, including CPT/HCPCS coding, the Medicare ASC payment system, and modifiers
• Advanced Excel and financial modeling skills
• Confident negotiator and clear communicator with payers, physicians, and executives

Preferred

• Experience in a multi-site ASC or surgical services organization
• Certification such as CRCR, CHFP, CPC, or CASCC
• Experience with ASC practice management systems (e.g. [HST, SIS, AdvantX, or your system]) and contract management or underpayment recovery software
• Familiarity with specialty-specific reimbursement (orthopedics, spine, GI, ophthalmology, pain management)
• Knowledge of the No Surprises Act and independent dispute resolution