Sr. Manager, Long Tail Acceptance
•Visa· 10h
💼 Sales⏰ Full-time🎯 Lead / Principal💰 $170k-271k🇺🇸 San Francisco, USA
10h ago
Reklamehealth·1 day ago
Sixty million adults experience mental health challenges in the United States, yet one-third lack access to proper care. Opioid overdose is the number one cause of death for people under 50 in the United States.
We are a clinician-led, tech-enabled provider group that exists to provide culturally competent behavioral health care addiction care, medication management, crisis intervention, and care coordination for people working towards taking back control of their lives, while expanding access to care.
Our vision at ReKlame Health is to create a future where individuals who have historically been unable to access the care they deserve can readily obtain high-quality behavioral health and addiction care.
At ReKlame Health, it goes beyond mere employment; it's about becoming a part of a formidable movement transcending individuality. Let's unite and forge a world where health equity and effortless access to exceptional mental healthcare can co-exist.
We are seeking a Strategic Coding & Revenue Integrity Manager to protect and optimize revenue in a complex Medicaid and managed-care environment. This role sits at the intersection of clinical documentation, coding strategy, integrity, and revenue risk.
This is not a production coding role. The position blends deep technical expertise with strategic oversight, focusing on pattern recognition, audit strategy, and payer-specific optimization. You will guide the team, enhance processes, and empower others to deliver results that align with our mission to improve health equity. The ideal candidate will thrive in navigating the rapidly evolving healthcare landscape while enabling ReKlame Health to scale efficiently.
Coding Strategy & Revenue Protection
Own CPT/ICD-10 coding and strategy across psychiatry and medication management, with a focus on high-acuity and complex patient populations.
Improve first-pass claim acceptance by proactively ensuring correct coding.
Own CPT/ICD-10 coding and strategy, with a focus on high-acuity and complex patient populations. Improve first-pass claim acceptance and minimize post-payment exposure to retroactive clawbacks and recoupments.
Develop payer-specific playbooks aligned with the fee schedule provided by our partners. Create payer-specific guides that are consistent with the fee schedules provided by our partners.
Partner with Clinical Ops to ensure documentation supports billed services.
Audit & Pattern Recognition
Lead pre-bill and post-pay audits on a rolling basis.
Identify denial, reversal, and clawback patterns through EOB analysis and flag systemic risks to improve the process
Produce clear summaries of findings and recommendations.
RCM & Team Enablement
Translate insights into workflow and system improvements, working closely with Clinical Leadership, team members, tools, and technology (e.g., reducing variance in documentation quality across providers).
Establish training materials and feedback loops between providers and the administrative team, and escalation pathways for high-risk claims or payer disputes.
Serve as the senior coding authority for billers, AR/recovery experts, specialists, and RCM vendors.
Compliance & Documentation Quality
Ensure compliance and alignment with CMS, state Medicaid, and managed-care guidelines.
Monitor changes in payer policy and coding guidance.
Partner with the Credentialing team on the implementation of new payor contracts.
Revenue Cycle Leadership
Partner with Finance and Business Operations to Identify, evaluate, and implement best-in-market billing technologies and automation solutions to improve efficiency, reduce manual effort, and scale operations in line with growing claim volume.
Pinpoint, assess, and deploy leading billing technologies and automation solutions. The goal is to enhance efficiency, minimize manual labor, and ensure operational scalability as claim volume increases.
Continuously recognize and implement opportunities to accurately capture reimbursement for patient care and procedures.
Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification in medical coding is mandatory.
Technical Skills: Advanced proficiency with ICD-10, CPT, and HCPCS coding systems and experience with EHR and medical billing software.
Experience: Minimum of 5-10 years of professional experience in medical coding and billing, including expertise with Medicare and Medicaid systems. Proven track record in audits, compliance, and revenue protection/integrity.
Strong preference for candidates with experience in behavioral health coding.
Leadership Skills: Demonstrated experience leading and mentoring a team, with a history of improving performance and operational workflows.
Detail-Oriented: Exceptional accuracy and attention to detail in coding/billing and documentation.
Regulatory Knowledge: Strong understanding of HIPAA and healthcare compliance guidelines, with the ability to adapt to changing regulations.
Communication Skills: Exceptional written and verbal communication abilities to effectively collaborate with stakeholders at all levels.
Problem-Solving Expertise: Analytical mindset with the ability to address complex challenges, identify solutions, and implement improvements with speed and accuracy. Must be comfortable with EOBs, patterns, and payer behavior.
Annual Compensation: $80,000-$100,000 (full-time)
Full Health Benefits: Medical, dental, and vision
Paid Time Off (PTO): 21 days of paid time off, including vacation and sick leave.
Professional Development: Unlock growth opportunities within a purpose-driven early-stage organization dedicated to creating a positive impact.
ReKlame Health considers several factors to ensure a fair and competitive offer when evaluating compensation packages. These include the scope and responsibilities of the role, the candidate's work experience, education, and training, as well as their essential skills. Internal peer equity is also examined to maintain balance within the organization. Additionally, current market conditions and overall organizational needs are crucial in shaping the final offer. Each aspect is thoughtfully reviewed before extending an offer, ensuring a comprehensive and equitable approach.
ReKlame Health is an equal opportunity employer. We celebrate diversity and are committed to creating a supportive and inclusive environment for all employees.
If you’re hungry for a challenge in 2025, love solving problems, and want to be a part of something transformational, we’d love to hear from you!
Learn more about us at www.ReKlamehealth.com
*We never ask for money or sensitive personal information during the job application process. If you receive an email or message claiming to be from us that requests such information, please do not respond and report it as a scam.