Revenue Cycle Manager

Florence Health•California, CA

1d•$95,000 - $100,000•Remote

About The Position

The Revenue Cycle Manager is the first full-time hire for Integrated Complex Care Associates (ICC) and is responsible for billing, provider enrollment, and billing compliance. The role reviews and releases every claim ICC submits to Medicare, enrolls and supports participating physicians, and serves as a billing contact for physician offices and patients. ICC is a California physician group serving patients with complex health needs. Physicians retain their own practices while joining ICC, which bills Medicare for their work under its group TIN. The position manages physician enrollment and onboarding, claim review and release, coding quality, Medicare payments and denials, patient billing support, compliance, and reporting. The role is employed by Integrated Complex Care MSO LLC, which handles employment, pay, and day-to-day administration. For coding, billing, and compliance decisions, the manager works under the direction of ICC physician leadership, follows approved policies, and refers questions about physician documentation to the physician. ICC has final authority over how a service is billed. This is a full-time, exempt, remote position for someone living in California. The manager works Pacific time business hours and may travel occasionally to physician offices around the state. Base pay is $95,000 or more, depending on experience and location; the posted salary range is $95,000–$100,000 per year. Offers are contingent on a background check after a conditional offer, OIG and SAM exclusion checks, and HIPAA training before system access.

Requirements

At least 5 years of Medicare Part B professional billing experience for physician groups, including claim review, denials, and appeals.
Hands-on Medicare provider enrollment experience, including PECOS, 855I reassignments, 855B group enrollment, and revalidations.
Current coding credential: CPC or CPB (AAPC), or CCS-P (AHIMA).
Working knowledge of ICD-10-CM, CPT/HCPCS, modifiers, and documentation standards for HCC risk adjustment.
Experience managing claims through a clearinghouse or billing portal, including submissions, rejections, and remittances (837P, 277CA, 835).
Billing compliance experience, including audits, exclusion screening, overpayment refunds, and HIPAA.
Clear, patient phone and writing skills when communicating with physicians, office staff, and older patients.
Comfort working independently as a first hire and building processes from scratch.
Must live in California and be available for Pacific time business hours.

Nice To Haves

CRC (risk adjustment) credential.
Familiarity with Medicare ACO programs, such as MSSP, ACO REACH, or LEAD.
Spanish language skills.

Responsibilities

Own provider enrollment, including physician 855I reassignments to ICC, ICC 855B practice locations, PECOS and NPPES updates, revalidations, and Medicare EFT and remittance setup.
Set up each physician's office to submit ICC patient claims through ICC's payer ID and confirm the first claims flow end to end.
Maintain ICC's provider roster as physicians join or leave, including records of who each physician is paid through.
Serve as the main billing contact for physician offices, answer questions, provide short onboarding sessions, and promptly resolve submission problems.
Explain payment reports to physicians and how ICC payments relate to their practices' billing.
Review every claim before Medicare submission; check CPT/HCPCS codes, modifiers, place of service, units, and diagnosis codes, and approve, correct, or return claims to physician offices.
Release approved claims to Medicare (Noridian, Jurisdiction E) under ICC's TIN and track claims through payment or denial.
Regularly sample claims against the physician's EMR of record for ICC patients to confirm documentation supports billing, and track error rates by physician.
Use Nightingale's HCC view to identify potentially undocumented conditions, send compliant, non-leading queries when appropriate, and code only conditions the physician documents.
Give physicians and staff specific coding feedback and escalate patterns to ICC physician leadership.
Post and reconcile Medicare remittances (835s); work rejections and denials; and file corrections, reopenings, and appeals.
Answer physician and office staff questions about claims, remittance status, and payment reports.
Reconcile Medicare payments to ICC with payments ICC makes to each physician or physician's practice.
Call each patient before their first ICC claim to explain how ICC will appear on Medicare statements and whom to contact with questions.
Answer patient billing questions and resolve concerns, working with physician offices as needed.
Screen every rendering physician and billing staff member monthly against the OIG exclusion list and SAM.
Maintain ICC billing and coding policies, document audits, and report findings to ICC physician leadership.
Identify, report, and return Medicare overpayments within the federal 60-day rule.
Access physicians' EMRs only for ICC patients and only to the extent needed for each task, in accordance with HIPAA.