virtahealth
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 Back End Manager is stepping into an environment that requires both immediate stabilization and the design of scalable, durable processes. This role requires deep expertise in payer-specific denial management, AR follow-up, and collections — and the leadership ability to build and develop a team capable of executing at the level Virta's growth requires.
Claim Receipt & Submission Confirmation - Establish and maintain active monitoring of ANSI X12 277CA claim acknowledgment transactions to confirm payers have received submitted claims - Implement a tracking and escalation process for claims that have not received 277CA acknowledgment within defined payer-specific windows - Partner with the Front End Revenue Cycle Manager and Engineering to ensure clean claim submission and minimize rejection rates at the clearinghouse level - Maintain working knowledge of clearinghouse workflows and claim status tracking capabilities Accounts Receivable Management - Own the Athena Health AR aging report — ensuring it accurately reflects payment status and is actively worked on a defined cadence - Establish AR follow-up workflows by payer and aging bucket, with defined SLAs and escalation paths for each tier - Drive systematic reduction of the over-180-day AR balance through targeted payer follow-up, appeals, and collections activity - Coordinate with Finance and the Manager/Director of Operational Effectiveness to ensure AR balances in Athena are accurately reflected in Zuora and NetSuite through a defined reconciliation process - Identify and escalate AR balances where the insurance collection path has been exhausted and the employer guarantee of payment clause may apply Denial Management - Build and manage a structured denial work queue in Athena Health with assigned ownership, defined SLAs, and a clear resubmission process for each denial reason code - Analyze denial trends by payer, reason code, and service line to identify root causes and implement upstream controls to prevent recurrence - Prioritize denial resolution based on dollar value and timely filing window expiration — ensuring high-value, near-deadline denials are worked first - Establish appeals workflows for payer-specific appeal processes, including supporting documentation requirements and submission timelines - Monitor denial overturn rates by payer and reason code, and use outcomes data to refine appeal strategies - Partner with the Front End Revenue Cycle Manager to address eligibility-driven denials at the root — denials reflecting coverage terminations that should have been caught upstream Collections - Manage the collections process for both claims-billed payer populations - Establish payer-specific follow-up protocols including call queues, correspondence templates, and escalation timelines - Coordinate with Client Success on employer group collections, including communication protocols and escalation to the employer guarantee of payment process when appropriate - Monitor and report on cash collection rates by payer against contracted PMPM rates, identifying and investigating variances Team Leadership & Development - Recruit, onboard, and develop back-end RCM staff including AR follow-up specialists, denial management analysts, and collectors - Establish competency requirements, training programs, and performance expectations for all back-end positions — with particular emphasis on experienced denial management and collections hires - Conduct regular AR review sessions with staff to ensure accounts are being worked effectively and escalations are appropriate - Build a culture of accountability, data-driven decision making, and continuous improvement within the back-end team 90 DAY PLAN Within your first 90 days at Virta, we expect you will do the following: - AR over 180 days: Reduce from 40% to <20% within 3 months - Overall denial rate: Reduce to <5% of submitted claims - Denial overturn rate: >60% of appealed claims successfully overturned - Timely filing write-off rate: Near zero — prevention through upstream controls and active monitoring - Days Sales Outstanding (DSO): Establish baseline; target reduction to <45 days within 12 months - 277CA acknowledgment rate: 100% of submitted claims confirmed received by payer - Cash collection rate: Actual cash collected vs. contracted PMPM — by payer
- 7+ years of revenue cycle management experience with a focus on back-end functions — AR management, denial management, and collections - Deep expertise in payer-specific denial reason codes, appeal processes, and timely filing requirements across major commercial payers - Demonstrated experience reducing AR aging and improving denial overturn rates in a complex payer environment - Experience with Athena Health or comparable practice management and claims system — specifically AR follow-up and denial management workflows - Proven ability to build and lead a collections and denial management team - Demonstrates a proactive use of AI tools to improve individual output and efficiency VALUES-DRIVEN CULTURE Virta’s company values drive our culture, so you’ll do well if: - You put people first and take care of yourself, your peers, and our patients equally - You have a strong sense of ownership and take initiative while empowering others to do the same - You prioritize positive impact over busy work - You have no ego and understand that everyone has something to bring to the table regardless of experience - You appreciate transparency and promote trust and empowerment through open access of information - You are evidence-based and prioritize data and science over seniority or dogma - You take risks and rapidly iterate Is this role not quite what you're looking for? Join our Talent Community https://jobs.ashbyhq.com/virtahealth/form/talent-community-form and follow us on Linkedin https://www.linkedin.com/company/virta-health to stay connected! Virta has a location based compensation structure. Starting pay will be based on a number of factors and commensurate with qualifications & experience. For this role, the compensation range is $117,000 - $135,000. Information about Virta’s benefits is on our Careers page at: https://www.virtahealth.com/careers. As part of your duties at Virta, you may come in contact with sensitive patient information that is governed by HIPAA. Throughout your career at Virta, you will be expected to follow Virta's security and privacy procedures to ensure our patients' information remains strictly confidential. Security and privacy training will be provided. As a remote-first company, our team is spread across various locations with office hubs in Denver and San Francisco. Clinical roles: We currently do not hire in the following states: AK, HI, RI Corporate roles: We currently do not hire in the following states: AK, AR, DE, HI, ME, MS, NM, OK, SD, VT, WI. Virta uses Ashby as its applicant tracking system, which incorporates AI-powered tools (provided by OpenAI, AWS, and Google Gemini) in certain aspects of the recruiting process, including application review, candidate screening, and interview note taking; your data is not used to train AI models, and all final hiring decisions are made by Virta Health personnel. For more information, see Ashby's AI Terms at https://www.ashbyhq.com/resources/terms-ai-features #LI-remote