Healthcare RCM Manager, Insurance Verification and Referral Operations

Manager, Insurance Verification And Referral Operations Our RCM Team is growing and hiring a Manager, Insurance Verification and Referral Operations! This position is fully remote, and we are willing to consider candidates based on location. The Manager, Insurance Verification & Referral Operations is responsible for leading and overseeing insurance verification, eligibility, referral, coordination of benefits, and financial clearance operations that support timely patient access, preserve provider utilization, minimize preventable denials, and protect revenue integrity across the organization. This role oversees front-end revenue cycle workflows to ensure patients are appropriately verified, financially cleared, and referred prior to service whenever possible. This position partners closely with operational, scheduling, clinical, revenue cycle, and offshore teams to drive efficient workflows, improve communication, support utilization, and minimize preventable eligibility, referral, and insurance-related delays that may impact patient care or operational performance. The Manager is responsible for supporting operational performance through workflow optimization, standardized procedures, escalation management, accountability, and continuous process improvement initiatives. This role requires a highly motivated operational leader with strong knowledge of insurance verification, eligibility, referrals, payer requirements, healthcare operations, utilization impact, and front-end revenue cycle workflows. This position is expected to operate with a high degree of ownership, initiative, accountability, operational leadership, and cross-functional collaboration. Duties and Responsibilities:

• Lead and oversee daily insurance verification, eligibility, referral, coordination of benefits, and financial clearance operations across multiple markets, practices, and service lines.
• Partner collaboratively with offshore operational teams to support workflow coordination, communication standards, turnaround times, quality outcomes, and operational consistency.
• Ensure insurance verification, referral, and financial clearance activities are completed accurately, timely, and in compliance with payer requirements, operational standards, and organizational expectations.
• Develop and maintain standardized workflows, escalation pathways, and communication protocols to support timely resolution of eligibility, referral, and financial clearance issues.
• Monitor eligibility, referral, and financial clearance workflows and proactively communicate, escalate, and resolve issues that may impact patient scheduling, provider utilization, continuity of care, or revenue cycle performance.
• Utilize athenaOne, payer portals, reporting tools, and operational dashboards to monitor workflow performance, productivity, referral completion, and operational outcomes.
• Support uninsured and underinsured patient workflows, including coordination of benefits review and resolution of incomplete or inaccurate insurance information.
• Understand key nephrology operational and revenue drivers and prioritize workflows based on patient access needs, scheduling urgency, operational impact, and revenue integrity.
• Identify process improvement and automation opportunities to improve turnaround times, reduce manual work, improve data accuracy, and support scalable operational growth.
• Establish, monitor, and report on operational KPIs including eligibility accuracy, referral turnaround time, financial clearance completion, coordination of benefits accuracy, productivity metrics, denial trends, utilization impact, and front-end revenue cycle performance indicators.
• Assist with staff development, workflow education, operational training, and continuous improvement initiatives to support team performance and operational consistency.
• Perform other duties and responsibilities as required, assigned, or requested.

Functional and Technical Competencies:

• Strong knowledge of insurance verification, eligibility, referral management, coordination of benefits, and front-end revenue cycle workflows.
• Demonstrated understanding of the operational and financial impact of eligibility delays, referral deficiencies, inaccurate insurance information, and financial clearance barriers on provider utilization, clinic schedules, denial prevention, patient access, and revenue cycle performance.
• Strong understanding of payer requirements, Medicare, Medicaid, commercial insurance workflows, and coordination of benefits processes.
• Experience utilizing athenaOne, payer portals, reporting tools, and operational dashboards to manage workflow performance and operational outcomes.
• Highly effective communication, cross-functional collaboration, and operational escalation skills with the ability to proactively resolve issues impacting patient access, provider utilization, clinic operations, and revenue integrity.
• Strong analytical, organizational, communication, problem-solving, and operational leadership skills.
• Ability to operate effectively in fast-paced, evolving operational environments with a high degree of accountability, initiative, and ownership.

Job Requirements:

• Bachelor's degree preferred or equivalent combination of education and relevant healthcare operations experience.
• Minimum of 5 years of progressive healthcare revenue cycle, insurance verification, eligibility, referral, or financial clearance experience.
• Minimum of 2 years of leadership or supervisory experience within healthcare operations or revenue cycle management.
• Strong experience managing insurance verification, eligibility, referral, or financial clearance operations within physician practice, specialty care, or large-scale healthcare environments.
• Experience collaborating with offshore teams and supporting large-scale operational workflows.
• Advanced experience using athenaOne/athenahealth.
• Experience with insurance verification, referral management, coordination of benefits, denial prevention, and workflow optimization.
• Experience within nephrology, dialysis, ESRD, or specialty physician practice environments strongly preferred.
• Experience with Epic, AdvancedMD, and/or Veradigm preferred.
• Experience leading operational process improvement initiatives preferred.
• Lean Six Sigma, PMP, CRCR, or related operational certifications preferred.
• Demonstrated desire and capability to grow into broader operational leadership responsibilities.

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