Manager, Front End Revenue Cycle

Title: Manager, Front End Revenue Cycle

Location: Remote

Department: Finance & Legal

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 in Athena

• Identify and resolve eligibility discrepancies, retroactive terminations, and coverage changes before they result in denied claims or revenue loss

• Monitor eligibility-related denial trends and implement upstream controls to reduce recurrence

Claims Entry & Submission Integrity

• Oversee the accuracy and completeness of claims preparation and entry across all Virta Health products — Diabetes Reversal, Diabetes Management, and Sustainable Weight Loss

• Ensure all claims are coded correctly and submitted within payer-specific timely filing windows

• Monitor claim submission lag — the time between billing period close and claim submission — and establish benchmarks to reduce exposure

• Work with Engineering to improve the flow of billing trigger data from Spark into Athena, reducing manual intervention in claims entry

• Implement pre-submission claim scrubbing processes to improve clean claim rates and reduce first-pass rejections

• Maintain working knowledge of CPT, HCPCS, and ICD-10 coding requirements relevant to Virta Health's digital health and value-based care model

Provider Credentialing

• Manage provider and program credentialing and payer enrollment for all applicable Virta Health providers, locations, and product lines

• Ensure all providers are enrolled with payers prior to service delivery to prevent claim denials related to credentialing status

• Maintain a credentialing tracking system with defined renewal timelines, expiration alerts, and re-credentialing workflows

• Coordinate with Legal, HR, and Clinical Operations on provider onboarding and payer network participation requirements

Team Leadership & Development

• Recruit, onboard, and develop front-end RCM staff including eligibility specialists, claims entry staff, and credentialing coordinators

• Establish role-specific SOPs, training programs, and performance expectations for all front-end positions

• Conduct regular performance reviews and provide coaching to develop staff competency in eligibility verification, coding, and claims entry

• Partner with the Manager/Director of Operational Effectiveness on reporting and process improvement initiatives affecting front-end functions

90 Day Plan

Within your first 90 days at Virta, we expect you will do the following:

• Eligibility file completeness rate: 100% of required fields present before member activation

• RTE verification rate: 100% of members verified via 270/271 before claim submission

• Clean claim rate: >95% claims accepted on first submission

• Claim submission lag: Claims submitted within 5 business days of billing period close

• Credentialing current rate: 100% of active providers enrolled with applicable payers

• Eligibility denial rate (CO-27): Reduction to <2% of submitted claims

Must-Haves

• 5+ years of revenue cycle management experience with a focus on front-end functions — eligibility, claims entry, and/or credentialing

• Strong working knowledge of ANSI X12 EDI transactions including 270/271 (eligibility), 837 (claims), and 835 (remittance)

• Experience with Athena Health or comparable practice management/claims system

• Demonstrated ability to manage cross-functional relationships with Client Success, Engineering, and clinical teams

• Experience in healthcare technology, digital health, or value-based care environments preferred

• 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

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 $93,000 - $107,000. 

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.

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