Virta Health
Healthcare
Manager,FrontEndRevenueCycle
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optimal for Manager candidates.
“Manager, Front End Revenue Cycle at Virta Health. Skills: Revenue cycle management, Claims processing, Provider credentialing. Own end-to-end member eligibility process. Define client eligibility file completeness”
What You'll Achieve.
100% eligibility file completeness; 100% RTE verification; >95% clean claim rate; Claims submitted within 5 business days; 100% credentialing current rate; Reduce eligibility denial rate to <2%
Industry & Context.
Root cause analysis
What They're Looking For.
Must Have
5+ years revenue cycle management experience, Focus on front-end functions, Working knowledge of ANSI X12 EDI transactions, Experience with Athena Health or comparable system, Demonstrated ability to manage cross-functional relationships
Nice to Have
Experience in healthcare technology, Experience in digital health, Experience in value-based care environments
What You'll Do.
Own end-to-end member eligibility process
Define client eligibility file completeness
Enforce client eligibility file completeness
Implement real-time eligibility verification
Manage real-time eligibility verification
Develop reconciliation process
Maintain reconciliation process
Identify eligibility discrepancies
Resolve eligibility discrepancies
Monitor eligibility denial trends
Implement upstream controls
Oversee accuracy of claims preparation
Oversee completeness of claims entry
Ensure claims coded correctly
Submit claims within filing windows
Monitor claim submission lag
Establish benchmarks to reduce exposure
Improve flow of billing trigger data
Reduce manual intervention in claims entry
Implement pre-submission claim scrubbing
Improve clean claim rates
Reduce first-pass rejections
Maintain working knowledge of coding requirements
Manage provider credentialing
Manage program credentialing
Manage payer enrollment
Ensure providers enrolled with payers
Prevent claim denials
Maintain credentialing tracking system
Coordinate with Legal on provider onboarding
Coordinate with HR on provider onboarding
Coordinate with Clinical Operations on provider onboarding
Coordinate with Legal on payer network participation
Coordinate with HR on payer network participation
Coordinate with Clinical Operations on payer network participation
Recruit front-end RCM staff
Onboard front-end RCM staff
Develop front-end RCM staff
Establish role-specific SOPs
Establish training programs
Establish performance expectations
Conduct performance reviews
Provide coaching to staff
Partner on reporting initiatives
Partner on process improvement initiatives
How You'll Work.
Team & Collaboration
Cross-functional relationships; Client Success; Engineering; Clinical teams; Manager/Director of Operational Effectiveness
Full Job Description
Virta Health is on a mission to reverse metabolic disease in one billion people. Current treatment approaches aren’t working—over half of US adults have either type 2 diabetes or prediabetes, and obesity rates are at an all-time high. Virta is changing this by helping people reverse their metabolic condition through innovations in technology, personalized nutrition, and virtual care delivery reinvented from the ground up. We have raised over $350 million from top-tier investors, and partner with the largest health plans, employers, and government organizations to help their employees and members restore their health and take back their lives. Join us on our mission to reverse metabolic disease in one billion people. The Front End Revenue Cycle Manager is responsible for the accuracy, completeness, and timeliness of all upstream revenue cycle activities at Virta Health. This role owns the critical entry points of the revenue cycle — member eligibility, claims entry, and provider credentialing — which directly determine whether a billable claim can be submitted and collected. The Front End Manager ensures that every member who receives a Virta Health service has a verified, complete record in the billing system before a claim is generated, and that all providers and programs are credentialed and enrolled with payers in a timely manner. RESPONSIBILITIES Eligibility Management - Own the end-to-end member eligibility process — from receipt of client eligibility files through verification of active insurance coverage in Athena Health - Define and enforce client eligibility file completeness standards; establish intake SLA with Client Success for incomplete or missing demographic and insurance data - Implement and manage real-time eligibility (RTE) verification (using ANSI X12 270/271) transactions to confirm active coverage before claims are submitted - Develop and maintain a reconciliation process to ensure all active members in Zuora have corresponding verified records
Applying for this Manager, Front End Revenue Cycle role?
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