# Manager, Front End Revenue Cycle

**Company:** [Virta Health](https://hotfix.jobs/companies/virta-health)
**Location:** Remote
**Role:** Revenue Operations
**Salary:** $93k – $107k/yr
**Experience:** 5+ years
**Skills:** Athena Health, Ansi X12, 270/271, 837, 835, Cpt, Hcpcs, Icd-10, Zuora, Spark
**Posted:** 2026-06-08

> Manages front-end revenue cycle operations including eligibility verification, claims entry, and provider credentialing for a digital health company. Requires 5+ years RCM experience and expertise with Athena Health and ANSI X12 transactions.

## Job Description

## Responsibilities

### Eligibility Management
- Own the end-to-end member eligibility process — from receipt of client eligibility files through verification of active insurance coverage in Athena Health
- Define and enforce client eligibility file completeness standards; establish intake SLA with Client Success for incomplete or missing demographic and insurance data
- Implement and manage real-time eligibility (RTE) verification (using ANSI X12 270/271) transactions to confirm active coverage before claims are submitted
- Develop and maintain a reconciliation process to ensure all active members in Zuora have corresponding verified records in Athena
- Identify and resolve eligibility discrepancies, retroactive terminations, and coverage changes before they result in denied claims or revenue loss
- Monitor eligibility-related denial trends and implement upstream controls to reduce recurrence

### Claims Entry & Submission Integrity
- Oversee the accuracy and completeness of claims preparation and entry across all Virta Health products — Diabetes Reversal, Diabetes Management, and Sustainable Weight Loss
- Ensure all claims are coded correctly and submitted within payer-specific timely filing windows
- Monitor claim submission lag — the time between billing period close and claim submission — and establish benchmarks to reduce exposure
- Work with Engineering to improve the flow of billing trigger data from Spark into Athena, reducing manual intervention in claims entry
- Implement pre-submission claim scrubbing processes to improve clean claim rates and reduce first-pass rejections
- Maintain working knowledge of CPT, HCPCS, and ICD-10 coding requirements relevant to Virta Health's digital health and value-based care model

### Provider Credentialing
- Manage provider and program credentialing and payer enrollment for all applicable Virta Health providers, locations, and product lines
- Ensure all providers are enrolled with payers prior to service delivery to prevent claim denials related to credentialing status
- Maintain a credentialing tracking system with defined renewal timelines, expiration alerts, and re-credentialing workflows
- Coordinate with Legal, HR, and Clinical Operations on provider onboarding and payer network participation requirements

### Team Leadership & Development
- Recruit, onboard, and develop front-end RCM staff including eligibility specialists, claims entry staff, and credentialing coordinators
- Establish role-specific SOPs, training programs, and performance expectations for all front-end positions
- Conduct regular performance reviews and provide coaching to develop staff competency in eligibility verification, coding, and claims entry
- Partner with the Manager/Director of Operational Effectiveness on reporting and process improvement initiatives affecting front-end functions

## 90 Day Plan
- Eligibility file completeness rate: 100% of required fields present before member activation
- RTE verification rate: 100% of members verified via 270/271 before claim submission
- Clean claim rate: >95% claims accepted on first submission
- Claim submission lag: Claims submitted within 5 business days of billing period close
- Credentialing current rate: 100% of active providers enrolled with applicable payers
- Eligibility denial rate (CO-27): Reduction to

## Must-Haves
- 5+ years of revenue cycle management experience with a focus on front-end functions — eligibility, claims entry, and/or credentialing
- Strong working knowledge of ANSI X12 EDI transactions including 270/271 (eligibility), 837 (claims), and 835 (remittance)
- Experience with Athena Health or comparable practice management/claims system
- Demonstrated ability to manage cross-functional relationships with Client Success, Engineering, and clinical teams
- Experience in healthcare technology, digital health, or value-based care environments preferred
- Demonstrates a proactive use of AI tools to improve individual output and efficiency

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