Your opportunity

We are seeking a Manager, Claims Payable to oversee all aspects of claims payments from CMS, including code recognition, compliance, claims processing, and claims payment disbursement. This role ensures the timely and accurate processing of claims in alignment with value-based care payment models. This role manages a team of professionals and works across departments to drive excellence in claims processing functions.

What You Will Do

Claims Payables Management

• Lead and manage the claims payables team, ensuring accurate and efficient claims processing.

• Lead weekly calls with Claims Processing System company to ensure adherence to data setup within the system.

• Facilitate the exchange of CRF and CCLF claim files for optimal data management with Claims Processing System

• Collaborate with roster management to ensure proper set up of practices within the Claims Processing System.

• Ensure timely and accurate claim payments, aligning with quality and productivity targets – to include those claims that come to the system improperly setup and work .

• Develop strategies to enhance claims processing workflows and streamline operations.

• Collaborate with finance, contracting, and provider relations teams to align claims payment processes with value-based care models.

• Work with TPAs and vendor partners to ensure adherence to service level agreements.

• Prepare and present reports on claims processing performance, highlighting key metrics and identifying areas for improvement.

• Audit claims processing activities to ensure accuracy, proper reimbursement, and regulatory compliance.

• Stay up to date with industry trends, regulatory changes, and best practices related to value-based care reimbursement models.

• Manage EDI enrollments with the ACO payer ID, assist provider groups, and audit ACH payment information for accuracy.

• Conduct provider education sessions before program years to ensure adherence to Vytal Step requirements and program expectations.

People Management & Development

• Mentor employees, conduct performance evaluations, and provide coaching to facilitate individual and team development.

• Lead team meetings focused on collaboration, education, and process improvement.

• Develop and oversee training programs to ensure staff proficiency in revenue cycle and claims payables processes.

• Foster a culture of continuous learning and professional development.

• Ensure teams have the tools, resources, and support needed to meet performance goals.

• Monitor team productivity and implement strategies to improve efficiency and accuracy.

• Promote cross-functional collaboration to enhance team engagement and business success.

• Ensure effective resource allocation and manage team structures, including onshore and offshore staff.

• Implement process improvements, , and foster a high-performance culture across teams.

Regulatory Compliance & Risk Management

• Ensure adherence to federal, state, and payer regulations, including HIPAA, CMS, and value-based care guidelines.

• Implement internal audits to ensure compliance with billing regulations and maintain high coding accuracy.

• Monitor regulatory updates and payer policy changes, adjusting processes accordingly

What will make you successful here

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field required preferred.

• 5+ years of experience in revenue cycle management, with a demonstrated track record of success in optimizing revenue cycle performance.

• 3+ years of management experience, including leading a team of direct reports.

• Offshore team management preferred

• Certification in medical coding preferred (e.g. CPC, CPB, or RHIA)

• Strong understanding of CMS claims processes and best practices

• Experience with ACOs, ACO REACH, MSSP programs

• Excellent analytical, problem-solving, and decision-making skills

• Strong leadership and management skills, with the ability to motivate process leadership through continual feedback and recognition.

• Ability to work across time zones and manage onshore/offshore teams.

• High level of accountability, initiative, and attention to detail.

• Comfortable operating in a fast-paced, evolving healthcare environment.

• Strong alignment with organizational values and mission-driven culture.

• Proficient with Microsoft Office Suite or related software.

Perks/Benefits

• Competitive base compensation

• Annual bonus potential

• Health benefits effective on start date; 100% coverage for base plan, up to 90% coverage on all other plans for individuals and families

• Health & Wellness Program; up to $300 per quarter for your overall well-being available on start date

• 401K plan effective on the first of the month after your start date; 100% of up to 4% of your annual salary

• Unlimited (or generous) paid "Vytal Time", and 5 paid sick days after your first 90 days

• Company paid STD/LTD

• Technology setup

• Ability to help build a market leader in value-based healthcare at a rapidly growing organization

Please note at no time during our screening, interview, or selection process do we ask for additional personal information (beyond your resume) or account/financial information. We will also never ask for you to purchase anything; nor will we ever interview you via text message. Any communication received from a Vytalize Health recruiter during your screening, interviewing, or selection process will come from an email ending in @vytalizehealth.com