Manager, Front End Revenue Cycle

Role Overview

The Front End Revenue Cycle (RCM) Manager is responsible for the accuracy, completeness, and timeliness of upstream revenue cycle activities. This role owns key entry points including member eligibility, claims entry, and provider credentialing, ensuring claims can be submitted and collected.

Responsibilities

Eligibility Management

• Own the end-to-end member eligibility process from client eligibility files through verification of active insurance coverage in Athena Health.
• Define and enforce client eligibility file completeness standards and establish an SLA with Client Success for missing/incomplete demographic and insurance data.
• Implement and manage real-time eligibility (RTE) verification using ANSI X12 270/271 transactions.
• Maintain reconciliation between Zuora active members and verified records in Athena Health.
• Identify and resolve eligibility discrepancies, retroactive terminations, and coverage changes before they cause denials or revenue loss.
• Monitor eligibility denial trends and implement upstream controls to reduce recurrence.

Claims Entry & Submission Integrity

• Oversee accurate and complete claims preparation and entry across Virta Health products (Diabetes Reversal, Diabetes Management, Sustainable Weight Loss).
• Ensure correct coding and timely submission within payer-specific timely filing windows.
• Track claim submission lag (time between billing close and claim submission) and set benchmarks to reduce exposure.
• Partner with Engineering to improve billing trigger data flow from Spark into Athena, reducing manual intervention.
• Implement pre-submission claim scrubbing to improve clean-claim rates and reduce first-pass rejections.
• Maintain working knowledge of CPT, HCPCS, and ICD-10 coding requirements for digital health and value-based care.

Provider Credentialing

• Manage provider and program credentialing and payer enrollment for all applicable Virta Health providers, locations, and product lines.
• Ensure providers are enrolled with payers prior to service delivery to prevent credentialing-related claim denials.
• Maintain credentialing tracking with 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 (eligibility specialists, claims entry staff, credentialing coordinators).
• Create role-specific SOPs, training programs, and performance expectations.
• Conduct performance reviews and coach staff to strengthen competency in eligibility verification, coding, and related processes.