Job Description

Job Location: Flourish Imaging - Gainesville, GA 30501
Position Type: Full Time
Job Category: Health Care
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.
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. Analytics, Reporting & Continuous Improvement
Develop reporting frameworks for reimbursement, denials, and payer performance. Partner with leadership on forecasting and drive continuous process improvement.
8. 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.