Revenue Cycle Manager

This is a fully remote position, open to applicants in California.

📋 Description

• Take full responsibility for billing, provider enrollment, and billing compliance for Integrated Complex Care Associates.

• Facilitate the enrollment and onboarding of physicians, which includes handling 855I reassignments, 855B practice locations, PECOS and NPPES updates, revalidations, and setting up Medicare EFT/remittance.

• Set up physician offices to process ICC patient claims using ICC's payer ID and ensure a smooth end-to-end claims flow.

• Maintain an accurate provider roster, which includes physician payment arrangements.

• Act as the primary billing contact for physician offices and lead onboarding sessions.

• Review each claim prior to submission to Medicare, ensuring accuracy in CPT/HCPCS codes, modifiers, place of service, units, and diagnosis codes.

• Approve, amend, or return claims to physician offices; submit approved claims to Medicare under ICC's TIN.

• Monitor claims through the payment or denial process.

• Sample claims against physician EMRs, track physician error rates, and issue compliant documentation queries when necessary.

• Provide coding feedback and escalate patterns to physician leadership.

• Post and reconcile Medicare remittances, address rejections and denials, and manage corrections, reopenings, and appeals.

• Reconcile Medicare payments to ICC with the payments made to physicians or physician practices.

• Explain the ICC billing process to patients and address any billing inquiries.

• Conduct monthly screenings of rendering physicians and billing staff against OIG and SAM exclusion lists.

• Uphold billing and coding policies, perform document audits, and report findings to physician leadership.

• Identify, report, and return Medicare overpayments within the federal 60-day regulation.

• Utilize physician EMR access solely for ICC patients and as required under HIPAA guidelines.

• Work under the guidance of ICC physician leadership while receiving administrative support from Integrated Complex Care MSO LLC.

⛳️ Requirements

• A minimum of 5 years’ experience in Medicare Part B professional billing for physician groups, encompassing claim review, denials, and appeals.

• Practical experience with Medicare provider enrollment, including PECOS, 855I reassignments, 855B group enrollment, and revalidations.

• Current coding credential: CPC or CPB (AAPC) or CCS-P (AHIMA).

• Proficient understanding of ICD-10-CM, CPT/HCPCS, modifiers, and HCC risk-adjustment documentation standards.

• Experience with claims management through a clearinghouse or billing portal, including 837P, 277CA, and 835 formats.

• Background in billing compliance, including audits, exclusion screenings, overpayment refunds, and HIPAA regulations.

• Familiarity with Medicare ACO programs such as MSSP, ACO REACH, or LEAD is advantageous.

• Excellent communication skills, both verbal and written, to interact effectively with physicians, office staff, and older patients.

• Proficiency in Spanish is a plus.

• Ability to create processes independently and work autonomously.

• Must reside in California.

• Availability to work during Pacific time business hours.

🏝️ Benefits

• Opportunity for remote work within California.

• Work hours aligned with Pacific time.

• Occasional travel to physician offices throughout California.

• Background check required following a conditional offer.

• OIG and SAM exclusion check conducted.

• HIPAA training provided prior to system access.