Senior Manager, Payer Rules & Revenue Cycle Optimization

Cardinal Health; Field (KY); Presencial; USD 90.000 - 130.000; Jornada completa

Descripción de la vacante

Cardinal Health is seeking a Manager of Payer Rules & Revenue Cycle Optimization to lead payer rule implementation across the revenue cycle. You will oversee a team of three FTEs and coordinate with Payer Relations, Market Access, RCM Operations, IT, and Business Transformation to improve billing accuracy and collections.

The role requires translating contracts and policies into system rules, ensuring readiness for new contracts, and proactively monitoring payer policy changes.

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.

Responsabilidades

• Lead, coach, and manage a team of three FTEs; establish priorities, allocate work, monitor quality and productivity, develop team capabilities, and ensure timely completion of payer rule and contract implementation requests.
• 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.

Conocimientos

Leadership

Team management

Educación

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

Descripción del empleo

Cardinal Health is seeking a Manager of Payer Rules & Revenue Cycle Optimization to lead payer rule implementation across the revenue cycle. You will oversee a team of three FTEs and coordinate with Payer Relations, Market Access, RCM Operations, IT, and Business Transformation to improve billing accuracy and collections.

The role requires translating contracts and policies into system rules, ensuring readiness for new contracts, and proactively monitoring payer policy changes.