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Remote Medicare Risk Adjustment Jobs in Texas (NOW HIRING)

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Remote Medicare Risk Adjustment information

What is the difference between Remote Medicare Risk Adjustment vs Remote Medical Coding Specialist?

AspectRemote Medicare Risk AdjustmentRemote Medical Coding Specialist
CertificationsCPR, CPC, or RAC certifications often preferredCPC, CCS, or CCS-P certifications
Work EnvironmentHealthcare insurance companies, Medicare plansHospitals, clinics, insurance companies
Industry UsagePrimarily in Medicare risk adjustment programsMedical billing and coding across various healthcare settings

Remote Medicare Risk Adjustment and Remote Medical Coding Specialist roles share certifications and healthcare industry usage but differ in focus. Medicare Risk Adjustment involves analyzing patient data to optimize Medicare plan reimbursements, while Medical Coding Specialists translate medical records into billing codes. Both roles require healthcare knowledge but serve distinct functions within the healthcare revenue cycle.

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For Remote Medicare Risk Adjustment jobs in Texas, the most frequently searched job titles are:

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Remote Medicare Risk Adjustment jobs near you
Infographic showing various Remote Medicare Risk Adjustment job openings in Texas as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Senior Manager - Revenue Cycle (Texas)

Astrana Health, Inc.

Houston, TX • Remote

$80K - $120K/yr

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Description
The Senior Manager of Revenue Cycle is responsible for leading end-to-end revenue cycle operations, including claims management, payment posting, denials and appeals, accounts receivable, and patient collections. You will partner closely with clinical teams, finance, and risk adjustment teams to optimize cash flow, reduce revenue leakage, improve billing accuracy, and ensure regulatory compliance. Planning, organizing, and influencing department activities while overseeing day-to-day operations to ensure accuracy in the billing processes. Monitor budget and utilize operational resources, participate in billing process improvement to maximize reimbursement.

What You'll Do
  • Oversee charge capture and reconciliation, claims submission and editing, payment posting and reconciliation, denial management and appeals, A/R management and collection, credit balance resolution
  • Evaluate current Athena hold rules for appropriateness and propose and implement changes where appropriate
  • Ensure accounts are billed accurately and timely by providing proactive oversight and direction for billing teams
  • Support accurate and timely month-end close activities
  • Report key KPIs to finance and market leadership including net collection rate, days in A/R, denial rate, clean claim rate, point-of-service collections, etc. Identify trends and operational deficiencies, implementing corrective action plans as necessary
  • Monitor and manage the billing staff regularly for work accuracy including charge retrieval, claims submissions and payment posting, holding team accountable for success
  • Maintain current knowledge of hospital billing systems and government payer systems, including applicable federal/state laws and regulations, as well as all aspects of third-party reimbursement policies and practices
  • Understand the contract terms and ensure appropriate payment
  • Participate in the development and implementation of operating policies and procedures
  • Audit current procedures to monitor and improve the efficiency of revenue cycle operations

Qualifications
  • Bachelor’s degree or equivalent education, preferred 
  • 7+ years' experience in revenue cycle/healthcare 
  • Billing: 3+ years’ experience in a leadership role 
  • Athena experience required 
  • Excellent critical thinking, organizational and time management skills with a strong attention to detail, accuracy and follow through 
  • Proven history of proactively identifying, resolving, and escalating issues that impact business outcomes 
  • Possess complete understanding of the billing/collection process to resolve complex, outstanding claims 
  • Demonstrated strong and persuasive verbal, written, and interpersonal communication skills 
  • Proven track record showing good decision-making skills based upon a mixture of analysis, experience, and judgment 
  • Proven ability to work collaboratively in a team environment in a positive and professional manner 
  • Demonstrated strong knowledge of commercial and/or regulatory claims billing including relevant Federal, State, and local laws and regulations and requirements 
  • Strong knowledge of third-party reimbursement, government reimbursement regulations, third party and patient billing, managed care agreements, account follow-up, account resolution, and cash applications 
  • Proven extensive knowledge of EDI billing systems and third-party payor billing process management 

Environmental Job Requirements and Working Conditions
  • This is a remote position with occasional travel to the Houston and Beaumont locations as needed. 
  • The national target pay range for this role is $80,000 - $120,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.