01Overview
Job Description Establish and maintain active monitoring of ANSI X12 277CA claim acknowledgment transactions to confirm payers have received submitted claims Implement a tracking and escalation process for claims that have not received 277CA acknowledgment within defined payer-specific windows Partner with the Front End Revenue Cycle Manager and Engineering to ensure clean claim submission and minimize rejection rates at the clearinghouse level Maintain working knowledge of clearinghouse workflows and claim status tracking capabilities Own the Athena Health AR aging report ensuring it accurately reflects payment status and is actively worked on a defined cadence Establish AR follow-up workflows by payer and aging bucket, with defined SLAs and escalation paths for each tier Drive systematic reduction of the over-180-day AR balance through targeted payer follow-up, appeals, and collections activity Coordinate with Finance and the Manager/Director of Operational Effectiveness to ensure AR balances in Athena are accurately reflected in Zuora and NetSuite through a defined reconciliation process Identify and escalate AR balances where the insurance collection path has been exhausted and the employer guarantee of payment clause may apply Build and manage a structured denial work queue in Athena Health with assigned ownership, defined SLAs, and a clear resubmission process for each denial reason code Analyze denial trends by payer, reason code, and service line to identify root causes and implement upstream controls to prevent recurrence Prioritize denial resolution based on dollar value and timely filing window expiration ensuring high-value, near-deadline denials are worked first Establish appeals workflows for payer-specific appeal processes, including supporting documentation requirements and submission timelines Monitor denial overturn rates by payer and reason code, and use outcomes data to refine appeal strategies Partner with the Front End Revenue Cycle Manager to address eligibility-driven denials at the root denials reflecting coverage terminations that should have been caught upstream Manage the collections process for both claims-billed payer populations Establish payer-specific follow-up protocols including call queues, correspondence templates, and escalation timelines Coordinate with Client Success on employer group collections, including communication protocols and escalation to the employer guarantee of payment process when appropriate Monitor and report on cash collection rates by payer against contracted PMPM rates, identifying and investigating variances Recruit, onboard, and develop back-end RCM staff including AR follow-up specialists, denial management analysts, and collectors Establish competency requirements, training programs, and performance expectations for all back-end positions with particular emphasis on experienced denial management and collections hires Conduct regular AR review sessions with staff to ensure accounts are being worked effectively and escalations are appropriate Build a culture of accountability, data-driven decision making, and continuous improvement within the back-end team Requirements 7+ years of revenue cycle management experience with a focus on back-end functions AR management, denial management, and collections Deep expertise in payer-specific denial reason codes, appeal processes, and timely filing requirements across major commercial payers Demonstrated experience reducing AR aging and improving denial overturn rates in a complex payer environment Experience with Athena Health or comparable practice management and claims system specifically AR follow-up and denial management workflows Proven ability to build and lead a collections and denial management team Demonstrates a proactive use of AI tools to improve individual output and efficiency Benefits Offers Equity .
