Senior Manager of Front-End RCM Operations

The Senior Manager of Front-End RCM Operations leads the end-to-end patient access, financial clearance, coding, and charge entry functions with primary focus areas including insurance verification, medical necessity review, prior authorizations, patient financial communication, coding accuracy, and charge capture. This role ensures timely and accurate data entry, proper coding, compliant charge posting, and clean claim generation to minimize denials, accelerate reimbursement, and support an optimal patient experience. The leader drives team performance, optimizes workflows, implements policy and system enhancements, and collaborates cross-functionally across clinical, billing, and RCM departments to support organizational revenue goals.

Essential Duties and Responsibilities:

• Establishes department goals focused on turnaround time, accuracy, first-pass approval rates, and clean claim rates.
• Partners with Human Resources to develop staffing models, training plans, productivity standards, and KPI dashboards across all front-end, coding, and charge entry functions.
• Promotes a performance-driven culture focused on accuracy, compliance, timeliness, and patient experience.
• Partners with clinical leaders to ensure documentation completeness for timely payer review and accurate charge capture.
• Oversees daily coding and charge entry operations to ensure timely, accurate, and compliant posting.
• Ensures encounter forms, provider documentation, and clinical notes are complete and accurate for coding and charge posting.
• Oversees coding workflows including CPT, ICD-10, and HCPCS accuracy in alignment with payer rules and compliance standards.
• Collaborates with Providers, Coders, Billing, and Clinical teams to resolve coding discrepancies, missing charges, documentation gaps, and clearinghouse edits.
• Monitors charge lag, coding turnaround time, reconciliation workflows, and missing charge queues to support clean claims and timely billing.
• Develops and implement standardized SOPs, policies, and audit processes for front end, coding and charge entry.
• Partners with Coding leadership (or serves as the coding lead where applicable) to ensure regulatory compliance and ongoing coder/provider education.
• Works with IT and system administrators to optimize coding templates, charge entry workflows, automation tools, and system configurations.
• Serves as the primary liaison for external vendors supporting eligibility, authorization, patient access, coding, or charge entry functions.
• Leads vendor selection, onboarding, implementation, and ongoing performance evaluation.
• Monitors vendor performance against SLAs and compliance standards.
• Recommends optimizations to improve results, quality, and efficiency.
• Oversees accuracy and timeliness of scheduling, demographic entry, insurance verification, benefit checks, and financial counseling.
• Ensures prior authorizations are obtained for all required procedures and payers.
• Collaborates with billing, coding, and collections to resolve front-end errors that impact claim submission and reimbursement.
• Utilizes system tools (e.g., eligibility checks, authorization dashboards, charge capture worklists) to identify and correct data gaps.
• Maintains compliance with federal and state regulations, industry standards, and payer policies.
• Performs quality audits on registration accuracy, authorization documentation, coding accuracy, and charge posting.
• Supports ongoing staff and provider education on coding rules, payer requirements, and documentation standards.
• Tracks and report KPIs including registration accuracy, authorization turnaround time, coding accuracy, charge lag, POS collections, and eligibility denials.
• Analyzes trends and collaborate with IT and RCM leadership to enhance workflows and system configurations.
• Leads or participate in cross-functional revenue cycle improvement initiatives.
• Provides data-driven insights to improve operational efficiency, coding compliance, and patient access metrics.
• Checks and responds to work e-mail on a regular basis throughout the workday.
• Participates in and complete all required trainings and in-services.
• Other duties as assigned.

Minimum Qualifications: