Revenue Cycle Manager – Care Management Billing

This is a fully remote position, open to applicants in United States, +1 more country.

📋 Description

• Take charge of payment reconciliation and billing for new partner practices.

• Conduct monthly analysis of claim-level payments to identify unpaid, underpaid, denied, or inaccurately adjusted claims.

• Manage payer follow-up and denial resolution processes, including rebills, appeals, coding adjustments, and front-end corrections.

• Ensure accurate and timely entry and correction of claims across various EHR and practice management systems.

• Supervise billers and contractors, delegate tasks, set priorities, and monitor throughput.

• Facilitate denials and billing team meetings, as well as regular one-on-one sessions.

• Generate monthly productivity reports, perform sample-based quality audits, and provide coaching to team members.

• Review claims for compliance with ICD-10-CM and CPT coding standards.

• Develop and maintain diagnosis pairing guides and coding tip sheets specific to various programs.

• Draft and uphold standard operating procedures (SOPs) for claim entry and billing workflows.

• Lead the billing implementation process for new partner practices utilizing RTM, CCM, and PCM services.

• Act as the escalation point for billing issues in active practices and engage in billing and collections discussions.

• Communicate denial and underpayment trends to clinical operations and customer success teams.

• Revamp billing processes to enhance accuracy and reduce collection time.

• Collaborate with engineering on billing requirements, tool testing, and automation initiatives.

• Enhance eligibility checks, benefits verification, and patient enrollment procedures.

⛳️ Requirements

• A minimum of 5 years of direct revenue cycle experience in physician practices or ambulatory billing, covering A/R follow-up, denial management, and payment reconciliation.

• At least 2 years of experience in leading or supervising billers, coders, or a denials team.

• Proficient understanding of CPT and ICD-10-CM coding guidelines, especially related to care management codes (RTM, CCM, PCM).

• Familiarity with Medicare, Medicare Advantage, and commercial payers, including direct interactions with payer representatives.

• Experience working with multiple EHR and practice management systems.

• Strong skills in spreadsheet analysis, including the use of pivot tables and lookups for claim-level evaluations.

• Excellent written communication skills; comfortable drafting SOPs and presenting insights to clients and leadership.

• CPC, CPB, or CRCR certification is a plus.

• Experience collaborating with engineering teams on billing automation is an added advantage.

• Background in a growth-stage healthcare services company is desirable.

• Authorization to work in the United States or Canada is required.

• No current or future visa restrictions to work in the United States or Canada.

🏝️ Benefits

• Opportunity for a compensation review after six months.

• Remote work flexibility.

• Chance to lead and establish a scalable billing function.