[Remote] Senior Manager, Revenue Cycle Management, Provider Operations

Note: The job is a remote job and is open to candidates in USA. Oscar Health is a health insurance company built around a full stack technology platform and focused on serving its members. The Senior Manager, Revenue Cycle Management, Provider Operations will lead and optimize revenue cycle operations across Oscar Medical Group, including billing, coding, claims, denials, eligibility, and documentation. The role will establish scalable strategies, controls, reporting, and workflows while partnering cross-functionally to improve revenue capture, reimbursement, compliance, and financial performance.

Responsibilities

• Own the strategy and performance of OMG's revenue cycle function, including professional billing, coding, claims management, denials, eligibility, documentation, and related workflows
• Serve as the senior subject matter expert for coding and billing, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, and payer requirements
• Establish and monitor revenue cycle KPIs and controls, using data and root-cause analysis to improve clean claims, coding accuracy, reimbursement, denial rates, and overall financial performance
• Lead coding and documentation integrity strategies, including pre- and post-bill review, provider queries, addendums, signatures/co-signatures, identification of inappropriate documentation practices or cloning, and proactive provider education to address documentation gaps and support accurate coding
• Lead denial prevention and resolution strategies, identifying systemic trends and partnering across teams to implement sustainable corrective actions
• Partner with clinical leadership on ICD-10/HCC documentation and coding, identifying opportunities to improve accurate capture of clinically supported diagnoses
• Evaluate payer-specific performance, requirements, and coding considerations, developing strategies to address reimbursement, eligibility, claim edits, denials, and other revenue cycle issues while incorporating payer expertise into coding and operational processes
• Partner cross-functionally with Clinical Operations, Finance, Compliance, Credentialing, Product/Technology, and other stakeholders to resolve complex revenue cycle issues and support new programs and services
• Develop scalable revenue cycle policies, workflows, governance, and vendor oversight to support a growing, multi-state provider organization
• Advise OMG leadership on revenue cycle performance, financial opportunities, operational risks, and recommended strategies, leading complex initiatives from identification through implementation and measurement
• Compliance with all applicable laws and regulations
• Other duties as assigned

Skills

• 7+ years of progressive experience in healthcare revenue cycle, professional billing, coding, or related healthcare operations
• 3+ years of experience leading revenue cycle programs, teams, or functions with accountability for operational and/or financial outcomes
• Advanced knowledge of professional billing and coding, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, claims management, denial management, and payer requirements
• Experience developing and executing revenue cycle strategies that improve coding accuracy, claims performance, reimbursement, and overall financial outcomes
• Experience with coding and clinical documentation integrity, including provider documentation review, provider queries, and pre- and post-bill review processes
• Demonstrated ability to analyze complex revenue cycle data, identify trends and root causes, and translate findings into actionable strategies and recommendations
• Demonstrated experience leading complex, cross-functional initiatives, partnering with clinical, operations, finance, compliance, credentialing, and other stakeholders to drive results
• Strong executive communication skills, with the ability to clearly communicate complex revenue cycle performance, risks, opportunities, and recommendations to senior leadership
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician-based (CCS-P), Certified Professional Medical Auditor (CPMA), or comparable coding/revenue cycle certification
• Experience leading or overseeing coding professionals and/or certified coders
• Experience working within a multi-state medical group, telehealth organization, or other complex healthcare delivery environment
• Experience working within both provider and payer environments, providing an understanding of revenue cycle from both perspectives
• Experience with risk-adjustment coding, including ICD-10/HCC documentation and coding practices
• Experience with credentialing and payer enrollment processes and their downstream impact on revenue cycle performance
• Experience managing external revenue cycle, coding, or billing vendors

Benefits

• Fully remote work for candidates residing in Dallas, TX
• Employee benefits
• Participation in Oscar's unlimited vacation program
• Annual performance bonuses
• Medical benefits
• Dental benefits
• Vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life insurance
• Disability insurance
• Paid wellness time and reimbursements

Company Overview

Company H1B Sponsorship