Manager, Front End Revenue Cycle

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 Apply To This Job