Revenue Cycle & Billing Operations Lead

It's fun to work in a company where people truly BELIEVE in what they're doing!

We're committed to bringing passion and customer focus to the business.

Summary

**This is a remote role**

PM Pediatrics is seeking a highly organized, analytical, and proactive Revenue Cycle & Billing Operations Lead with strong project management and medical billing expertise to support our growing Revenue Cycle Management (RCM) team. This individual will play a key role in coordinating payer-related initiatives, driving process improvements, managing cross-functional projects, and delivering accurate reporting to support leadership in data-driven decision-making.

The ideal candidate will bring a deep understanding of revenue cycle workflows, payer requirements, and claims management systems, along with the ability to independently manage multiple projects and timelines. A strong command of Excel and data analytics is essential, as is the ability to communicate effectively across teams and with external partners.

Description

Billing & Payer Project Management:

• Serve as a project lead on payer-related initiatives, tracking timelines, deliverables, and cross-departmental coordination.
• Support claim submission, denial management, and appeals workflows across RCM and Behavioral Health (BH) teams.
• Proactively monitor aging claims and payer issues, driving resolution through effective collaboration with billing vendors and internal stakeholders.
• Identify systemic denial trends, develop corrective action plans, and escalate complex issues appropriately.
• Ensure payer enrollments, credentialing updates, and clearinghouse requirements are on schedule and compliant.

Data Analysis & Reporting:

• Build and maintain dashboards, Excel-based reports, and trackers to measure revenue cycle performance (e.g., claim turnaround time, denial rates, collections).
• Support leadership with financial forecasting, reconciliation, and variance analysis.
• Organize and present data to support audits, compliance, payer reporting, and operational reviews.
• Develop standardized templates and reporting procedures to increase visibility and efficiency across teams.

Leadership & Operational Support:

• Act as a liaison between RCM leadership, billing vendors, and internal departments to ensure goals and timelines are met.
• Assist in creating and maintaining SOPs and documentation to support training and compliance.
• Drive continuous improvement by identifying workflow gaps and recommending scalable solutions.
• Support strategic initiatives by delivering insights that enhance reimbursement, reduce denials, and optimize operational efficiency.

#LI-KM1

Qualifications

• 2+ years of experience in medical billing, RCM operations, or healthcare project management.
• Demonstrated experience managing projects from initiation through completion.
• Advanced Microsoft Excel skills, including pivot tables, VLOOKUP, conditional formatting, and data modeling.
• Exceptional organizational skills and the ability to manage multiple priorities in a fast-paced environment.
• Excellent written and verbal communication skills, with the ability to interface with technical and non-technical teams.
• Ability to work independently, meet deadlines, and proactively drive process improvements.

Preferred Qualifications:

• Experience supporting Behavioral Health RCM functions.
• Familiarity with payer portals, EDI processes, and clearinghouse systems.
• Understanding of payer contract terms, credentialing requirements, and reimbursement methodologies.
• Experience working with outsourced billing vendors and coordinating multi-party projects.
• Prior involvement in audit preparation, payer compliance, or revenue integrity initiatives.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

EEO Statement

PM Pediatric Care is an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status or any other characteristic protected by law.