Revenue Accounting Manager

About Legent Health

At Legent Health, our mission is simple yet profound: “To provide first-class health care that puts YOU first.” Our vision reflects our commitment to excellence: “Through robust physician partnerships, become a nationwide leader in compassionate, quality healthcare focused on the patient and available to everyone.” Our values, also known as our brand pillars, define how we stay true to our identity in the healthcare industry and the communities we serve. These values are central to everything we do:

• Respect: We honor the time and trust of both patients and physicians by delivering organized, efficient services that ensure a seamless healthcare experience.
• Service: We are committed to highly personalized care for patients, their families, and the physicians who serve them, driving optimal outcomes for all.
• Leadership: We strive to be a trusted leader through innovation, clear communication, and unwavering dedication to excellence across our employees and partners.

Joining Legent Health means being part of a team that lives these principles every day, as we build a future focused on compassionate, quality care.

About the Role

The Revenue Accounting Manager is a senior member of the Finance and Accounting team, responsible for leading all aspects of revenue recognition, net revenue reporting, and the operational interface between accounting and revenue cycle management across Legent Health’s multi-facility platform. This role serves as the platform’s subject matter expert for healthcare net revenue, contractual allowance methodology, and revenue-related financial reporting. Reporting to the Assistant Controller with a dotted-line relationship to the SVP of Revenue Cycle Management, this individual is expected to build and lead a small team, establish scalable revenue accounting processes to support acquisitive growth, and deliver institutional-quality reporting to meet private equity sponsor expectations. The initial mandate centers on revenue recognition and RCM collaboration, with scope expanding over time to encompass broader accounting leadership responsibilities.

POSITION’S ESSENTIAL RESPONSIBILITIES:

Revenue Recognition & Net Revenue Leadership

• Own the end-to-end net revenue reporting process for all facilities, serving as the platform’s subject matter expert for monthly net revenue proofs, contractual allowance validation, and implicit price concession methodology.
• Develop, document, and maintain the company’s revenue recognition policies and procedures in compliance with ASC 606, including the portfolio approach practical expedient for grouping contracts by payer, facility, and specialty.
• Lead the monthly contractual allowance analysis across all payer classes, validating that estimated reimbursement rates align with actual collections and managed care contract terms.
• Oversee implicit price concession estimation using statistical models, historical collection patterns, and propensity-to-pay analysis; lead quarterly hindsight reviews and present findings to senior leadership.
• Manage third-party payer settlement reserves including Medicare APC/OPPS rate adjustments, and commercial managed care true-ups.
• Prepare and present revenue disaggregation disclosures, revenue by case analysis, and payer mix trending to support PE sponsor reporting, board materials, and lender covenant compliance.
• Monitor high-cost implant billing, supply cost pass-through reimbursement, and case-level profitability for all facilities, coordinating with operations on outlier identification.

RCM Interface & Cross-Functional Leadership

• Serve as the senior accounting point of contact for the Revenue Cycle Management organization, establishing and leading structured weekly meetings to review AR aging, denial trends, cash application accuracy, and payer performance.
• Design and maintain the data flow architecture between RCM billing systems (HST, CPSI) and the general ledger (Sage Intacct), ensuring completeness and accuracy of revenue-related data transfers.
• Develop standardized reconciliation procedures between the patient accounting system, general ledger, and bank deposits; identify and resolve systemic discrepancies across facilities.
• Partner with the SVP of RCM on charge capture validation, chargemaster maintenance, payer fee schedule updates, and denial management initiatives that directly impact revenue recognition.
• Establish and monitor revenue cycle KPI dashboards including DSO (target: 35–45 days), clean claim rate (target: >95%), denial rate (target: <3%), net collection rate (target: >96%), and Days in DNFB (target: <5 days).

PE Reporting & Strategic Finance

• Prepare revenue-related components of the monthly EBITDA bridge, including volume, rate, and payer mix decomposition for same-store versus acquired facility performance.
• Develop and maintain Adjusted EBITDA schedules with revenue-related add-backs and normalizations, including run-rate adjustments for recently acquired or opened facilities.
• Support quality of earnings (QoE) analyses during acquisition and exit scenarios, providing case-level revenue sustainability analysis, payer concentration risk assessment, and AR quality validation.
• Prepare facility-level P&L revenue components for all locations; deliver budget-versus-actual-versus-prior-year variance analysis with meaningful commentary.
• Build and maintain Power BI dashboards for executive and PE sponsor consumption, presenting revenue per case, DSO trending, EBITDA margin by facility, and payer performance analytics.
• Support net working capital true-up calculations as required under the purchase agreement, particularly AR and revenue-related accrual components.

Month-End Close & Process Excellence

• Lead the revenue close process within the targeted close calendar, ensuring all revenue-related journal entries, reconciliations, and supporting schedules are completed accurately and on time.
• Manage balance sheet reconciliations for accounts receivable, contractual allowance reserves, bad debt reserves, and third-party settlement accruals across all entities.
• Drive continuous improvement in the close cycle, identifying opportunities for automation, standardization, and process streamlining to support the company’s objective of reducing close timelines.
• Coordinate with external auditors, providing revenue-related audit support including walkthroughs, sample selections, and management representations.

Team Leadership & Incremental Scope

• Directly supervise the Revenue Accountant; mentor, develop, and evaluate team members to build a high-performing revenue accounting function.
• Recruit and onboard additional team members as the platform scales through acquisition, establishing training protocols for new facility onboarding and revenue accounting procedures.
• Over time, assume expanded accounting leadership responsibilities including oversight of additional general accounting functions, acquisition integration activities, and cross-functional projects.
• Serve as a key contributor to budget and forecast development, providing revenue assumptions, payer rate modeling, and case volume projections to the FP&A team.

Advanced Microsoft Excel – Complex financial modeling, pivot tables, Power Query, and data analysis (required).

SQL or data analytics tools for revenue data extraction and analysis (preferred).

EDUCATION AND EXPERIENCE REQUIREMENTS:

• Bachelor’s degree in Accounting, Finance, or closely related field (required).
• Master’s degree in Accounting, Finance, or MBA (preferred).
• CPA License (strongly preferred).
• HFMA Certified Healthcare Financial Professional (CHFP) or Certified Specialist in Accounting and Finance (CSAF) (strongly preferred).
• Certified Revenue Cycle Representative (CRCR) or Certified Management Accountant (CMA) (a plus).
• 7–10+ years of progressive accounting experience (required).
• Minimum 3–5 years of healthcare-specific accounting experience in ambulatory surgery centers, surgical hospitals, or multi-site provider organizations (required).
• 2–3 years of supervisory or team lead experience (required).
• Demonstrated expertise in healthcare revenue recognition under ASC 606, contractual allowance methodologies, and payer reimbursement analysis (required).
• Experience in private equity-backed or high-growth healthcare platforms with exposure to EBITDA bridge reporting, quality of earnings analyses, and acquisition integration (strongly preferred).
• Multi-entity, multi-facility accounting experience with consolidation and intercompany elimination (strongly preferred).
• Deep expertise in ASC 606 healthcare revenue recognition, including the portfolio approach, variable consideration, and implicit price concession frameworks.
• Comprehensive understanding of managed care contracting, payer reimbursement methodologies (APC/OPPS, DRG, case rates, percent-of-charge, bundled payments), and the end-to-end revenue cycle.
• Strong leadership and people management skills with the ability to build, develop, and retain a high-performing team.
• Executive presence and communication skills to effectively present to senior leadership, PE sponsors, and external stakeholders.
• Strategic mindset with the ability to connect revenue accounting data to business decisions, operational performance, and enterprise value creation.
• Process-driven with a continuous improvement orientation and comfort with change management in a high-growth, acquisitive environment.
• High degree of integrity, accountability, and attention to detail.
• Sage Intacct – General ledger, multi-entity consolidation, dimensional reporting, and financial statement design (required).
• Microsoft Power BI – Advanced dashboard development, DAX formulas, data modeling, and executive-level visualization (required).
• HST Pathways – Surgical scheduling, billing, case costing, and data extraction; expert-level proficiency (strongly preferred).
• CPSI (TruBridge) – Patient accounting, contract management, and revenue cycle modules (preferred).
• Advanced Microsoft Excel – Complex financial modeling, pivot tables, Power Query, and data analysis (required).
• SQL or data analytics tools for revenue data extraction and analysis (preferred).

Why Join Legent Health?

Legent Health fosters an environment where team members are empowered to deliver exceptional care while growing professionally within a supportive, values-driven culture.

We Offer:

• Competitive salary and performance incentives
• Comprehensive benefits package
• Paid time off and wellness programs
• Career development and training opportunities

Equal Employment Opportunity (EEO) Statement

Legent Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, disability status, or any other legally protected characteristic.

I-9 and E-Verify Compliance: Employment eligibility will be verified through the U.S. Department of Homeland Security’s E-Verify system. All applicants must provide valid documentation to establish identity and authorization to work in the United States, as required by federal law.

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