virtahealth - Senior Manager, Back End Revenue Cycle

• Claim Receipt & Submission Confirmation • 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 • Accounts Receivable Management • 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 • Denial Management • 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 • Team Leadership & Development • 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 • AR over 180 days: Reduce from 40% to Overall denial rate: Reduce to Denial overturn rate: >60% of appealed claims successfully overturned • Timely filing write-off rate: Near zero — prevention through upstream controls and active monitoring • Days Sales Outstanding (DSO): Establish baseline; target reduction to 277CA acknowledgment rate: 100% of submitted claims confirmed received by payer • Cash collection rate: Actual cash collected vs. contracted PMPM — by payer • 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 • Values-driven culture • Virta’s company values drive our culture, so you’ll do well if: • You put people first and take care of yourself, your peers, and our patients equally • You have a strong sense of ownership and take initiative while empowering others to do the same • You prioritize positive impact over busy work • You have no ego and understand that everyone has something to bring to the table regardless of experience • You appreciate transparency and promote trust and empowerment through open access of information • You are evidence-based and prioritize data and science over seniority or dogma • You take risks and rapidly iterate • Is this role not quite what you're looking for? 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