Revenue Cycle Manager

About this role

Department: Revenue Cycle
Reports To: Directors of Community Health & Operations
Classification: Exempt
Work Arrangement: Remote – California Based
Schedule: Monday – Friday | 8:30 AM – 5:00 PM
Compensation: $85,000 – $90,000 annually
About Pacific Health Group

Pacific Health Group (PHG) is committed to improving health outcomes by addressing the medical, behavioral, and social needs of the communities we serve. Through programs such as Enhanced Care Management (ECM), Community Supports (CS), Community Health Worker (CHW) services, Behavioral Health, and other community-based healthcare programs, PHG works collaboratively with health plans, providers, community organizations, and other partners to support whole-person care.
Our work is grounded in accountability, collaboration, innovation, integrity, and a commitment to improving access to high-quality services for vulnerable and underserved populations.
Position Summary
The Revenue Cycle Manager is responsible for the leadership, oversight, performance, and continuous improvement of Pacific Health Group's Revenue Cycle operations.
This position oversees the full revenue cycle, including billing, coding, claims submission, payment posting, accounts receivable, collections, denials, appeals, payer reconciliation, reimbursement analysis, and revenue reporting.
The Revenue Cycle Manager ensures services are appropriately supported by documentation, claims and encounters are submitted accurately and timely, outstanding revenue is actively managed, reimbursement discrepancies are identified and resolved, and Revenue Cycle activities comply with payer, contractual, regulatory, and organizational requirements.
This position provides direct leadership and oversight to assigned Revenue Cycle staff and collaborates closely with the Directors of Community Health & Operations, Finance, Quality Assurance, Operations, program leadership, Information Technology, health plans, and other internal and external stakeholders.
The Revenue Cycle Manager is expected to operate with a high degree of independence, accountability, urgency, and ownership. This individual must proactively identify risks, establish measurable performance expectations, develop solutions, implement corrective actions, and drive issues through resolution without requiring repeated leadership intervention.
Essential Duties and Responsibilities
Revenue Cycle Management & Operational Oversight

• Lead the day-to-day operations and overall performance of Pacific Health Group's Revenue Cycle function.

• Oversee billing, coding, claims submission, payment posting, accounts receivable, collections, denials, appeals, and reimbursement activities.

• Establish and maintain effective workflows, internal controls, performance standards, and accountability measures.

• Ensure claims and encounters are submitted accurately and within applicable payer and timely-filing requirements.

• Monitor outstanding, rejected, denied, unpaid, and underpaid claims through resolution.

• Identify revenue leakage, reimbursement delays, and operational barriers affecting revenue.

• Proactively develop and implement corrective action plans when Revenue Cycle performance falls below expectations.

• Ensure Revenue Cycle issues are actively managed through resolution rather than remaining outstanding without documented action.

• Promptly escalate significant financial, compliance, payer, or operational concerns to the Directors of Community Health & Operations.

Billing, Coding & Documentation Integrity

• Ensure accurate billing and coding in accordance with applicable ICD-10, CPT, HCPCS, modifiers, payer requirements, contractual requirements, and organizational standards.

• Ensure billed services are supported by appropriate and complete documentation.

• Identify documentation deficiencies that may prevent billing, delay reimbursement, cause denials, or create compliance concerns.

• Partner with Quality Assurance, Operations, and program leadership to address recurring documentation and billing deficiencies.

• Monitor unbilled claims and encounters and ensure identified issues are resolved timely.

• Maintain current knowledge of payer billing requirements and communicate changes that may affect PHG operations.

• Develop preventive processes to reduce documentation-related denials and reimbursement delays.

Accounts Receivable & Collections

• Maintain direct oversight of accounts receivable and collection activities.

• Review A/R aging and outstanding balances by payer, program, aging category, and reimbursement status.

• Establish priorities and follow-up expectations for outstanding receivables.

• Monitor aged accounts receivable, including balances exceeding 90 and 120 days.

• Ensure timely and documented follow-up on unpaid and underpaid claims.

• Identify and recover reimbursement that may otherwise be lost due to underpayments, missed billing, denials, or untimely follow-up.

• Monitor adjustments, refunds, credit balances, and write-offs to ensure accuracy and appropriate authorization.

• Establish strategies to reduce aged receivables and improve cash flow.

Denials, Rejections & Appeals Management

• Oversee the denial and rejection management process from initial identification through final resolution.

• Monitor and analyze denial trends by payer, program, denial reason, service type, and other relevant categories.

• Conduct root-cause analysis of recurring denials and implement corrective action plans.

• Ensure corrected claims and appeals are submitted within required deadlines.

• Monitor denial overturn rates and revenue recovered through appeals.

• Collaborate with internal departments to address operational, authorization, eligibility, or documentation issues contributing to denials.

• Implement preventive strategies to reduce avoidable denials and improve clean claim and first-pass acceptance rates.

Payer & Health Plan Management

• Serve as a primary Revenue Cycle contact…