RCM Front End Lead Specialist

Responsibilities

Claims Billing Implementations

• Lead and oversee the configuration and setup of new client billing accounts, ensuring operational readiness and accuracy.
• Partner with Engineering, Credentialing, Eligibility, and Finance teams on onboarding and payment setup.
• Maintain documentation for onboarding, configuration, and customer contract updates.
• Own and maintain the Price Book across billing and payer setups.
• Lead billing testing to validate configurations and prevent downstream issues.
• Interpret and apply eligibility, benefit, and coding details, including CPT, HCPCS, and ICD-10.
• Contribute to scaling implementation processes through documentation, automation recommendations, and workflow improvements.

Charge Entry Team Leadership

• Serve as a subject matter expert for front-end revenue cycle management processes and system integrations.
• Oversee Data and Charge Entry contractors and full-time employees, ensuring accurate deliverables.
• Lead small-to-medium process improvement projects focused on automation, accuracy, and scalability.
• Drive enhancements across Athena, Zuora, and Salesforce while maintaining accurate downstream billing logic.
• Mentor junior team members and contractors through knowledge sharing, work review, and effective problem-solving.
• Resolve differences constructively and align stakeholders through documentation, clear updates, and collaborative planning.

Requirements

• 3–5+ years of experience in healthcare revenue cycle management, including direct billing and payer implementations.
• Proven experience managing complex accounts, handling escalations, and resolving exceptions.
• Experience overseeing Data and Charge Entry contractors and workflows involving charge entry, reconciliation, and billing data.
• Advanced understanding of commercial and government payer policies, reimbursement methodologies, contract requirements, and CPT, HCPCS, and ICD-10 coding.
• Experience leading process improvement initiatives, analyzing data, identifying trends, and building reporting frameworks.
• Strong technical proficiency with Athena, Zuora, Salesforce, and JIRA or similar revenue cycle management systems.
• Excellent communication skills and a collaborative, solutions-focused mindset.
• Proactive use of AI tools to improve individual output and efficiency.

Nice-to-Haves

• Familiarity with product development or systems optimization.

Compensation and Benefits

• Compensation range: $59,000–$76,500 per year.
• Benefits information is available on Virta’s Careers page.
• The role may involve handling sensitive patient information governed by HIPAA; security and privacy training is provided.