Manager, Payer Rules – Revenue Cycle Optimization

Cardinal Health

. Lead, coach, and manage a team of three FTEs.

Posted 10/27/2026full-timeRemote • United StatesMid-LevelSenior💰 $89,000 - $114,480 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare revenue cycle management, payer operations, and reimbursement processes, with a strong focus on translating payer contracts into operational rules and ensuring compliance. Proven ability to lead teams, manage system configurations, and implement process improvements while maintaining high standards of accuracy and productivity.

Highest-signal resume keywords

Healthcare Revenue Cycle ManagementPayer OperationsLeadership and Team ManagementBrightree and InRule ExperienceClaims Processing and Denial Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Payer Contract TranslationOperational Process DevelopmentSystem Configuration ManagementAutomated Controls ImplementationData Analysis and Reporting

Soft Skills

Analytical SkillsCommunication SkillsProblem-Solving Skills

Tools & Technologies

BrightreeInRuleEDI ProcessesClearinghouse Systems

Industry Keywords

MedicareMedicaidMedicare AdvantageDMEPOSBilling Guidelines

About the role

Key responsibilities & impact

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 operational readiness for new payer contracts, renewals, amendments, and updates.
Translate payer contracts, reimbursement policies, and billing guidelines into system rules, business requirements, standard operating procedures, and controls across the revenue cycle.
Own accuracy and maintenance of payer-specific configurations within Brightree and InRule.
Partner with IT, system administrators, vendors, and clearinghouses on specifications, configuration changes, user acceptance testing, validation, and issue resolution.
Create governance for intake, prioritization, approval, documentation, auditing, and validation of payer rule changes.
Monitor Medicare, Medicaid, Medicare Advantage, commercial payer, and manufacturer policy updates and communicate impacts.
Investigate differences between contracted requirements, system configuration, and payer adjudication or reimbursement.
Analyze denials, rejections, unbilled claims, underpayments, and reimbursement variances to identify gaps and prioritize remediation.
Implement automated controls and payer-specific pre-bill edits.
Coordinate readiness, testing, training, and communication for payer rule changes; escalate risks and ensure gaps are closed.
Support Brightree transformation, integrations, and enterprise standardization efforts.
Develop metrics and report progress on implementation timeliness, configuration accuracy, denial trends, backlog, and revenue cycle improvements.
Direct oversight of policies and procedures execution.
Ensure Payer Rules FTEs operate within guidelines and remain compliant.

Requirements

What you’ll need

Bachelor's degree in healthcare administration, Business, Finance, Information Systems, or related field, or equivalent relevant experience preferred.
5+ years of experience in healthcare revenue cycle, payer operations, reimbursement, billing systems, or payer rules preferred.
Demonstrated leadership or supervision of staff.
Strong knowledge of payer contractual and billing requirements, claims processing, denial management, and translating business needs into operational processes and system rules.
Experience coordinating system configurations, change controls, testing, audits, and cross-functional process improvement.
Strong analytical, communication, and problem-solving skills.
DMEPOS or medical supply reimbursement preferred.
Brightree, InRule, or comparable rules engines experience; Medicare, Medicaid, Medicare Advantage and commercial payer requirements; EDI and clearinghouse processes preferred.

Benefits

Comp & perks

Medical, dental and vision coverage
Paid time off plan
Health savings account (HSA)
401k savings plan
Access to wages before pay day with myFlexPay
Flexible spending accounts (FSAs)
Short- and long-term disability coverage
Work-Life resources
Paid parental leave
Healthy lifestyle programs
Bonus eligible