Medical Billing Manager (Revenue Cycle - MSK)

VAIL-SUMMIT ORTHOPAEDICS PC•Grand Junction, CO

About The Position

The Medical Billing Manager is responsible for the strategic oversight and performance of the Clinic’s Revenue Cycle Management (RCM) function, with a focus on orthopedic and musculoskeletal (MSK) services. This role requires a deep understanding of physician practice billing, key performance indicators (KPIs), payer dynamics, and the operational realities of a physician-owned group practice. This position provides leadership across a hybrid RCM model, managing both internal billing staff and an external RCM partner. The Manager ensures alignment, accountability, and performance across all parties to optimize financial outcomes. The role moves beyond transactional billing responsibilities and focuses on driving performance, accountability, and continuous improvement. This role is accountable for achieving measurable improvements in revenue cycle performance and ensuring alignment across internal teams and external partners. The Manager partners closely with leadership, physicians, and external vendors to optimize reimbursement, improve processes, and ensure alignment with organizational goals. The ideal candidate understands the balance between maximizing appropriate reimbursement, maintaining compliance, and recognizing the unique dynamics of a physician-owned practice, where clinical judgment and patient relationships may influence billing and collection strategies.

Requirements

Deep expertise in Revenue Cycle Management within a physician group practice, preferably orthopedics/MSK
Strong understanding of RCM KPIs (Days in A/R, Net Collection Rate, Denial Rate, First Pass Resolution Rate, Lag Days) and demonstrated ability to translate these metrics into actionable performance improvement initiatives
Proven experience managing or working within a hybrid RCM model (in-house + outsourced/vendor)
Strong vendor management skills, including holding external partners accountable to performance standards
Advanced knowledge of Medicare, commercial payers, and reimbursement methodologies
Strong understanding of CPT, ICD-10, global surgical billing, and payer-specific nuances
Ability to balance compliance with revenue optimization, avoiding both over- and under-billing
Understanding of the business and cultural dynamics of physician-owned practices
Strong analytical, reporting, and problem-solving skills
Leadership experience with ability to drive change and accountability
Associates degree, preferably in business administration or related field; 7+ years of medical insurance/healthcare revenue cycle experience will be considered in lieu of the degree
Minimum of 3 years medical insurance/healthcare billing and collections experience in a medical practice health system, with a deep understanding of medical billing rules and regulations
Two years supervisory or management experience required

Nice To Haves

Certified Professional Coder (CPC) or equivalent certification preferred, or demonstrated equivalent experience in coding oversight and auditing
Bachelor degree preferred
Medical coding certification preferred
Orthopaedic experience preferred

Responsibilities

Lead and oversee all billing and collections operations across both internal staff and external RCM partner
Develop, monitor, and own performance against key RCM KPIs, including but not limited to: Days in A/R, Net Collection Rate (NCR), Denial Rate, First Pass Resolution Rate (FPRR), Charge Lag / Lag Days
Establish baseline targets and consistently drive performance towards industry benchmarks
Drive measurable improvement in these KPIs through process changes, team accountability, and vendor management
Demonstrated experience in coding oversight, auditing, and documentation improvement within a physician practice environment
Hold both internal team members and external vendors accountable to performance expectations and service level agreements (SLAs)
Identify trends, gaps, and opportunities, and implement process improvements to enhance overall revenue cycle performance
Provide regular reporting and actionable insights to executive leadership
Serve as the primary point of contact and relationship manager for the outsourced RCM company
Establish clear expectations, KPIs, and accountability measures for vendor performance
Conduct regular performance reviews and operational meetings with the vendor
Ensure proper coordination between internal workflows and outsourced functions (e.g., charge capture, coding, follow-up, denials)
Evaluate vendor performance and recommend changes or contract adjustments as needed
Hold external RCM partner accountable to defined KPI targets and service level expectations, with regular performance reviews and corrective action plans when targets are not met
Apply deep understanding of orthopedic/MSK billing, including surgical case complexity, global periods, and payer nuances
Partner with physicians and leadership to align billing practices with clinical workflows and business objectives
Recognize and appropriately navigate the dynamics of a physician-owned practice, including situations where aggressive collections may not align with physician preferences or patient experience goals
Ensure accurate and compliant coding and billing practices while optimizing reimbursement opportunities
Balance compliance requirements with strategic billing practices to avoid both underbilling and unnecessary conservatism
Oversee denial management strategy, including root cause analysis and corrective action plans
Utilize KPI data and trend analysis to prioritize initiatives, allocate resources, and drive continuous improvement in revenue cycle performance
Collaborate with clinical departments (providers, PT, imaging, DME, front desk) to improve charge capture and workflow efficiency
Serve as a key liaison between billing, operations, leadership, and external RCM partners
Lead training and education initiatives for staff and providers on billing practices and documentation requirements
Manage and develop internal billing staff while coordinating efforts with outsourced teams
Transition team focus from task-based work to performance-driven outcomes
Ensure appropriate staffing, workflow design, and role clarity within the billing function
Be knowledgeable and understanding of all aspects of the billing and coding staff duties to include: Entering patient demographics and insurance information
Verifying patient eligibility and benefits for upfront collection on unmet deductibles and co-insurance
Responsible for reviewing operative reports within three business days of procedure/surgery
Enter charges accurately according to insurance payers/contracts
Submitting clean claims by attaching necessary documentation for payment
Follow-up on electronic claims and paper claims
Posting insurance payments to patient accounts
Submit all secondary claims when necessary
Refund money owed to patient or insurances
Conduct self in a manner that reflects a positive representation of the company, and encourages others to do the same
Observe strict patient confidentiality in dealing with patients