Revenue Cycle Program Manager

About The Oncology Institute (www.theoncologyinstitute.com): 
Founded in 2007, The Oncology Institute (NASDAQ: TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI offers cutting-edge, evidence-based cancer care to a population of approximately 1.9 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With over 180 employed and affiliate clinicians and over 100 clinics and affiliate locations of care across five states and growing, TOI is changing oncology for the better. 

At The Oncology Institute, revenue cycle excellence isn’t just about financial performance—it’s about ensuring patients can access timely, compassionate, and cutting-edge cancer care. As a Revenue Cycle Program Manager, you play a critical role at the intersection of mission, strategy, and operational excellence. Your work directly supports patients during some of the most vulnerable moments of their lives. By optimizing reimbursement, improving access, and reducing administrative friction, you help ensure clinicians can focus on what matters most: delivering exceptional oncology care.

JOB PURPOSE AND SUMMARY:

The Revenue Cycle Program Manager leads enterprise oncology initiatives that improve professional and technical revenue cycle performance across fee‑for‑service and value‑based care models. This role oversees complex, cross‑functional programs that strengthen drug and infusion revenue integrity, reduce revenue leakage, improve cash flow, and support capitated oncology arrangements. The role requires deep oncology revenue cycle expertise and experience working with Unlimited Financials, McKesson iKnowMed, and Elekta MOSAIQ, with a strong ability to connect clinical, operational, financial, and payer teams.

ESSENTIAL DUTIES AND RESPONSBILITIES:

Program and Portfolio Leadership

• Lead a portfolio of oncology revenue cycle and value‑based care initiatives from planning through execution and sustained outcomes.
• Develop program charters, timelines, financial impact estimates, risk mitigation plans, and success metrics.
• Establish governance structures and provide regular executive‑level reporting on progress, risks, and realized benefits.

Oncology Fee‑for‑Service Revenue Cycle Optimization

• Drive end‑to‑end optimization of oncology professional and technical billing workflows, including:
  • Scheduling, eligibility, referrals, and prior authorization for chemotherapy, procedures, and radiation services
  • Registration accuracy and payer data integrity
  • Charge capture and coding for E&M, infusion, injections, radiation therapy, and supportive care
  • Drug acquisition cost alignment, waste documentation, and revenue integrity
  • Claims submission, clearinghouse edits, and payer adjudication
  • Denials prevention and appeals (medical necessity, authorization, drug coverage)
  • Accounts receivable follow‑up, underpayment identification, and collections
• Identify and remediate oncology‑specific revenue leakage (e.g., missed charges, incorrect modifiers, payer pathway restrictions, drug reimbursement variances).

Capitated & Value‑Based Oncology Revenue Enablement

• Partner with Value‑Based Care, Clinical, and Pharmacy teams to support:
  • Oncology‑specific value‑based arrangements
  • Alignment of care delivery with cost, quality, and utilization targets
  • Performance tracking for quality and utilization
• Support care management and supportive oncology services tied to alternative payment models.

Payer Performance, Authorizations & Contract Operations

• Collaborate with Managed Care and Authorization teams to:
  • Improve prior authorization accuracy and turnaround times
  • Reduce authorization‑related denials and treatment delays
  • Monitor payer adherence to oncology contract terms and reimbursement methodologies
  • Support escalation, appeals, and underpayment recovery efforts
• Translate payer oncology contract terms into operational workflows and billing rules.
• Prioritize and problem-solve issues, process gaps via RCA, Lean, Six Sigma or similar best practices.

Oncology Revenue Analytics & Financial Insight

• Define and track KPIs across FFS and capitated oncology models, including:
  • Clean claim rate, denial rate, and appeal overturn rate
  • Days in AR by payer and service type (infusion, radiation, professional)
  • Drug reimbursement variance and write‑off trends
  • Charge and coding lag for oncology encounters
  • Financial performance against capitated or bundled payment targets
• Partner with analytics teams to develop dashboards that support practice‑level and executive decision‑making.

Technology Enablement & System Optimization

• Lead or support revenue cycle initiatives involving:
  • Unlimited Financials(billing, AR, reporting, reconciliation)
  • McKesson iKnowMed(oncology EHR, charge capture, clinical documentation)
  • Elekta MOSAIQ(radiation oncology scheduling, treatment documentation, billing integration)
• Ensure accurate integration and workflow alignment across clinical, financial, and billing systems.
• Translate operational needs into business requirements, UAT scenarios, training plans, and adoption strategies.

Provider & Practice Change Management

• Partner with oncologists, radiation oncologists, nursing, pharmacy, and practice leadership to:
  • Improve documentation and charge capture accuracy
  • Reinforce authorization and pathway compliance
  • Drive adoption of standardized workflows across sites of care
• Develop SOPs, job aids, and training materials for clinical and revenue cycle teams.

Compliance, Revenue Integrity & Audit Readiness

• Ensure oncology billing and coding practices comply with payer policies and regulatory requirements.
• Partner with Compliance and Audit teams to address findings related to drug billing, medical necessity, and authorization.
• Support provider education and corrective action plans to mitigate compliance and financial risk.

FFS Oncology Performance

• Reduction in authorization‑ and medical‑necessity denials
• Improvement in drug reimbursement accuracy and timeliness
• Reduction in days in AR and write‑offs
• Improved charge capture and coding timeliness

Capitated / Value‑Based Oncology Performance

• Predictable performance against bundled or capitated targets
• Improved quality and utilization outcomes tied to incentive payments
• Reduced revenue variance and improved margin stability
• Live and exemplify TOI core values, providing outstanding customer service and promoting a positive experience for patients and staff members.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Deep understanding of oncology billing, coding, and payer dynamics
• Strong knowledge of infusion and radiation therapy workflows
• Familiarity with oncology value‑based payment models and pathways
• Exceptional stakeholder management and provider communication skills
• Strong financial and analytical acumen
• Advanced Excel and PowerPoint skills
• Experience with BI tools (Power BI, Tableau) preferred
• Ability to translate clinical workflows into system and revenue cycle requirements

REQUIRED EXPERIENCE, EDUCATION AND/OR TRAINING:

• Bachelor’s degree in Healthcare Administration, Business, Finance, or similar field
• Master’s degree (MBA, MHA, MPH) preferred
• 7 to 10+ years in healthcare revenue cycle, oncology operations, or consulting
• Experience working in oncology physician groups or cancer networks
• PMP or equivalent
• HFMA certifications (CRCR, CHFP)
• Lean Six Sigma Green or Black Belt
• Oncology revenue cycle or coding experience strongly preferred

PHYSICAL WORKING REQUIREMENTS:

The position involves prolonged periods of sitting at a desk, extensive computer use, and phone interaction. Additionally, the role may require occasional lifting of up to 20 pounds for office supplies or equipment.

The physical demands described above are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.