Revenue Cycle Manager

Pacific Health Group

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

Posted 10/6/2026full-timeCarlsbad • California • United StatesMid-LevelSenior💰 $85,000 - $90,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare revenue cycle management, including billing, coding, claims processing, and compliance with payer requirements. Proven ability to lead teams, establish performance standards, and implement corrective actions to optimize revenue and reduce denials.

Highest-signal resume keywords

Healthcare Revenue Cycle ManagementICD-10, CPT, HCPCS KnowledgeClaims Adjudication and Payer Contract AdministrationCertified Professional Coder (CPC)Healthcare Billing Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical BillingReimbursement ProcessesAccounts Receivable ManagementDenial ManagementRoot-Cause AnalysisPerformance AnalysisRevenue Cycle ReportingWorkflow OptimizationData AnalysisFinancial Reconciliation

Soft Skills

LeadershipCommunication SkillsOrganizational SkillsAttention to DetailIndependent Judgment

Tools & Technologies

Healthcare Billing PlatformsEHR SystemsMicrosoft Office SuiteReporting Tools

Certifications & Qualifications

Certified Revenue Cycle Representative (CRCR)Certified Revenue Cycle Professional (CRCP)

Industry Keywords

Managed Care ReimbursementHealthcare Billing RegulationsHIPAA CompliancePayer RequirementsCommunity-Based Healthcare Services

About the role

Key responsibilities & impact

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 workflows, internal controls, performance standards, and accountability measures
Ensure claims and encounters are accurate, timely, properly documented, and compliant with payer requirements
Monitor outstanding, rejected, denied, unpaid, and underpaid claims through resolution
Identify revenue leakage, reimbursement delays, operational barriers, and documentation deficiencies
Develop and implement corrective action plans and preventive strategies
Oversee accounts receivable, collections, aged balances, adjustments, refunds, credit balances, and write-offs
Manage denial and rejection processes, root-cause analysis, corrected claims, appeals, and recovery rates
Serve as a primary Revenue Cycle contact for health plans, insurance companies, and other payers
Reconcile claims, encounters, payments, expected reimbursement, remittance information, and payer discrepancies
Support payer contracts, fee schedules, billing requirements, and reimbursement methodologies
Collaborate with Operations, program leadership, Quality Assurance, Finance, Information Technology, health plans, and other stakeholders
Conduct billing, coding, claims, payment posting, collections, and compliance audits
Ensure compliance with payer requirements, healthcare billing regulations, contractual obligations, HIPAA, PHI requirements, and organizational policies
Develop Revenue Cycle reports, dashboards, performance analyses, and recommendations for leadership
Support month-end revenue reconciliation and investigate reimbursement variances
Supervise, coach, train, and evaluate assigned Revenue Cycle staff
Establish and monitor individual and departmental KPIs, productivity, quality, accuracy, and timeliness
Develop and maintain Revenue Cycle policies, procedures, workflows, and standard operating procedures
Lead process-improvement and automation initiatives to reduce denials, aged receivables, write-offs, and reimbursement delays
Report significant financial, compliance, operational, or payer risks to the Directors of Community Health & Operations

Requirements

What you’ll need

Minimum of five (5) years of progressive experience in healthcare revenue cycle management, medical billing, reimbursement, coding, healthcare finance, or a related field
Previous supervisory or management experience within Revenue Cycle operations
Demonstrated experience managing billing, claims, accounts receivable, collections, denials, appeals, and reimbursement processes
Strong working knowledge of ICD-10, CPT, HCPCS, modifiers, and healthcare billing practices
Strong understanding of managed care reimbursement, payer requirements, claims adjudication, and payer contract administration
Knowledge of healthcare billing compliance requirements, HIPAA, and protection of PHI
Proficiency with healthcare billing platforms, EHR systems, reporting tools, and Microsoft Office Suite, particularly Excel
Strong analytical skills with demonstrated ability to identify trends, conduct root-cause analysis, and implement corrective actions
Demonstrated ability to lead teams, establish accountability, manage performance, and oversee complex workflows
Excellent written and verbal communication skills
Strong organizational skills, attention to detail, independent judgment, and ability to manage competing priorities and deadlines
Bachelor's degree in Healthcare Administration, Finance, Accounting, Business Administration, or a related field; equivalent relevant experience may be considered (preferred)
Certified Professional Coder (CPC), Certified Revenue Cycle Representative (CRCR), Certified Revenue Cycle Professional (CRCP), or related credential (preferred)
Experience with Medi-Cal and California managed care organizations (preferred)
Experience supporting CalAIM Enhanced Care Management, Community Supports, Community Health Worker programs, Behavioral Health, or similar community-based healthcare services (preferred)
Experience managing multiple payer relationships and reimbursement methodologies (preferred)
Experience implementing or optimizing healthcare billing systems and automated Revenue Cycle workflows (preferred)
Experience working within a rapidly growing healthcare organization (preferred)
Must maintain confidentiality and safeguard financial, member, payer, and protected health information
Must work collaboratively across departments while maintaining clear accountability for Revenue Cycle responsibilities

Benefits

Comp & perks

Remote work arrangement
Flexible schedule based on organizational needs
Occasional in-person attendance for meetings, trainings, departmental activities, or organizational events
Full-time Monday–Friday schedule, 8:30 AM–5:00 PM