Revenue Cycle Manager

Retina Consultants San Diego•Poway, CA

3d•$80,000 - $105,000•Onsite

About The Position

The Revenue Cycle Manager (RCM) will play a crucial role in identifying patient reimbursement issues, ensuring that claims, denials, and appeals are efficiently processed, and resolving billing-related issues within our retina-focused practice. The RCM will lead the day-to-day operations of Revenue Cycle department, including but not limited to: insurance verification/pre-auth validation, defining/documenting billing policies and procedures, collection of patient responsibility (co-pays, outstanding balances), managing insurance data and validating accuracy/completeness in EMR and billing systems (e.g., coverage dates and place of service), ensuring clean claims submission, managing claims rejections/denials and coordination of benefits, ensuring timely and accurate posting of payer and patient payments, credit balance management, and overseeing our surgical operations.

Requirements

Ophthalmology – Retina revenue cycle experience required.
On-site in the Poway, CA office
At least 5 years of experience in the healthcare industry in revenue cycle management leadership role, including experience with revenue cycle, billing, payment posting, AR/denials management, and patient financial services.
Expert understanding of healthcare reimbursement/collections, medical billing, ICD10 coding, patient documentation, chart auditing, and state and federal regulations.
Demonstrate organizational skills.
Demonstrate effective verbal and written communication skills.
Demonstrate analytical skills when problem-solving.
Demonstrate high attention to detail and a high degree of accuracy.

Nice To Haves

Bachelor’s degree, preferred.
Nextech experience, preferred.

Responsibilities

Implementing a system to ensure that accurate billing information is entered into the billing system.
Supervising the revenue cycle department in various duties, such as account management, communications with insurance providers, collections, cash posting, contract analysis, and billing.
Managing staff performance by providing regular feedback, performance reviews, and one-on-one meetings.
Overseeing the hiring and training of staff. Manage a team of billing, revenue cycle, accounts receivable, and surgery coordinators.
Efficiently managing patient complaints in respect of billing and collections.
Planning and structuring the department workflow and staffing.
Correctly coding diagnoses and procedures.
Responsible for keeping abreast of Medicare, Medicaid (Medi-Cal), and other third-party payer rules and regulations with respect to billing and other matters and communicates this information to the physicians and providing guidance to staff.
Communications with third party vendors, clinical and non-clinical staff, physicians, patients and insurance companies to assist in managing department operations.
Develops key performance indicators (KPIs) dashboards, and process improvements to improve visibility and efficiency of the revenue cycle process.
Interacts with the Practice Administrator and accounting team to develop strategic plan for all functions related to the revenue cycle.
Take on additional responsibilities or special projects as directed by leadership to support the evolving needs of the practice.