Revenue Cycle Manager

Who we are:

Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support, capital and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO), Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level, so doctors can focus their efforts on what matters most - patient care. Headquartered in Stamford, Connecticut, the Spire network spans the Northeast with more than 165 physicians, 1,800 employees, 285 other clinical providers and 40 locations in New York, Connecticut, Rhode Island and Massachusetts.

What you'll do:

The Revenue Cycle Manager is responsible for the daily operational performance of assigned revenue cycle functions, including direct oversight of both internal staff and outsourced vendor partners. Reporting to the Director of Revenue Cycle Management, this role ensures claims are processed accurately and timely, denials are aggressively managed, and vendor performance meets established contractual and quality standards.

This is a hands-on leadership role requiring active monitoring of work queues, detailed review of quality results, and direct intervention when performance gaps are identified. The RCM Manager is accountable for operational execution, measurable improvement, and vendor quality control.

Responsibilities/Duties:

• Oversee day-to-day workflows across assigned functions (e.g., AR follow-up, billing, denial management, front-end clearance, charge entry, or payment posting).

• Monitor work queues, aging buckets, and claim edits to ensure timely resolution.

• Review high-dollar and complex accounts requiring advanced follow-up.

• Identify trends impacting cash flow and escalate systemic issues to the Director.

• Serve as the primary operational liaison for assigned RCM vendors.

• Conduct routine vendor performance reviews, including productivity, quality, and SLA adherence.

• Monitor vendor KPIs such as:

• Days in AR (by payer and aging bucket)

• Denial rate and overturn rate

• Productivity per FTE

• Clean claim rate

• Backlog volumes

• Validate vendor-reported metrics against internal data.

• Request and track corrective action plans when performance falls below expectations.

• Escalate persistent performance issues to the Director for contractual review.

• Perform internal quality audits of vendor work, including:

• AR follow-up documentation

• Appeal quality and timeliness

• Coding-related denials (if applicable)

• Write-offs and adjustments

• Develop and maintain QC scorecards.

• Identify training gaps and coordinate remediation with vendor leadership.

• Ensure adherence to organizational compliance policies and payer guidelines.

• Validate write-off thresholds and approval processes.

• Track and report on key revenue cycle metrics:

• Days in AR

• Denial rate and root causes

• Cash collections vs. target

• Unbilled inventory

• Productivity and quality scores

• Conduct denial root cause analysis and implement corrective workflows.

• Partner with Coding and Front-End leaders to address upstream drivers of denials.

• Supervise internal team members and/or leads.

• Set productivity and quality expectations.

• Conduct performance reviews and coaching sessions.

• Foster a culture of accountability and continuous improvement.

• Work closely with Coding, Charge Entry, Front-End, and Finance teams to resolve revenue-impacting issues.

• Support payer escalations and participate in payer meetings as needed.

• Assist the Director in preparing operational updates for senior leadership.