Lead PET/CT Revenue Cycle Management (49499)

Lead Pet/Ct Revenue Cycle Management

Flourish Imaging - Gainesville, GA 30501

Overview

Position Type Full Time Category Health Care

Description

Company Lead – Pet/Ct Revenue Cycle Management

Position Overview

The Company Lead of Pet/Ct Revenue Cycle Management is responsible for the end-to-end financial and operational performance of the revenue cycle for a rapidly expanding network of Pet imaging centers. This role will serve as the central architect of reimbursement strategy, ensuring successful payer enrollment, optimized contracting, and disciplined execution across all front-end and back-end revenue cycle functions. This individual will play a critical role in supporting the organization's national expansion strategy, with an initial rollout of four Pet centers and significant projected growth in 2026–2027. Given the high-cost nature of Pet radiopharmaceuticals and advanced imaging services, this role is directly accountable for securing accurate, timely, and compliant reimbursement.

Payer Enrollment & Credentialing Leadership

Lead all aspects of payer enrollment for new Pet/Ct sites, including CMS enrollment, site readiness coordination, survey management, and PTAN acquisition. Develop scalable workflows aligned with multi-state expansion and ensure enrollment timelines support operational go-live readiness.

Commercial Payer Contracting & Strategy

Lead commercial payer enrollment and contract negotiations. Optimize reimbursement for Pet/Ct procedures and radiopharmaceuticals. Develop payer-specific strategies including fee schedule optimization and network positioning.

Radiopharmaceutical Reimbursement Optimization

Ensure coverage and reimbursement for high-cost Pet radiopharmaceuticals. Monitor payer policies and align clinical, operational, and billing practices to minimize financial exposure and maximize reimbursement.

Front-End Revenue Cycle Controls

Establish best practices for scheduling, insurance verification, and authorization. Ensure accurate intake and reduce preventable denials through strong front-end discipline.

Coding, Compliance & Medical Necessity

Ensure coding accuracy and alignment with CPT/HCPCS and ICD-10 standards. Maintain compliance with NCD/LCD guidelines and implement audit processes to validate medical necessity.

Billing, Collections & AR Performance

Oversee charge capture, claims submission, denial management, and AR follow-up. Drive performance against KPIs including Days in AR, denial rates, and net collections.

Analytics, Reporting & Continuous Improvement

Develop reporting frameworks for reimbursement, denials, and payer performance. Partner with leadership on forecasting and drive continuous process improvement.

Cross-Functional Leadership

Collaborate across clinical, operations, finance, and external partners. Serve as subject matter expert on Pet reimbursement strategy and execution.

Qualifications

Required: • 7–10+ years of healthcare revenue cycle experience • Experience in diagnostic imaging or radiology • Expertise in CMS enrollment and payer contracting Preferred: • Pet/Ct and radiopharmaceutical reimbursement experience • Multi-site healthcare expansion experience • Knowledge of advanced imaging coding and payer policies

Core Competencies

• Strategic thinker with strong execution discipline • Deep payer and reimbursement expertise • Analytical and data-driven mindset • Strong negotiation skills • Ability to scale in high-growth environments

Success Metrics (First 90, 180, 360 days)

• CMS enrollment and PTAN issuance for all sites • Commercial payer contracts executed • 95% clean claim rate • Reduced denial rates • Improved AR performance and cash flow

Why This Role Matters

This is a mission-critical role directly tied to the financial viability of a high-cost, high-growth Pet imaging service line. This leader ensures full reimbursement capture while minimizing financial risk and enabling scalable growth.