Revenue Cycle Manager

Florence Health•California, CA

13d•Remote

About The Position

Integrated Complex Care Associates (ICC) is a California physician group serving patients with complex health needs, with care led by each patient’s primary physician. Physicians across California can join ICC while retaining their own practices; ICC bills Medicare for that work under its group TIN. The Revenue Cycle Manager is the group’s first full-time hire and owns billing, provider enrollment, and billing compliance. The role reviews and releases claims to Medicare, enrolls and supports physicians and their offices, answers billing questions from physicians and patients, and builds billing processes independently. The employee will work remotely from California during Pacific time business hours and may occasionally travel to physician offices around the state. The position is employed by Integrated Complex Care MSO LLC, which handles employment, pay, and day-to-day administration. For coding, billing, and compliance decisions, the role works under ICC physician leadership, follows ICC-approved policies, and refers questions about physician documentation to the relevant physician. ICC has final authority over how a service is billed. The position is full-time and exempt, with a base salary of $95,000 or more depending on experience and location; the listed 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.
Claims management experience 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.
Ability to build processes from scratch and work independently as a first hire.
Must live in California and work 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

Enroll and onboard physicians, including managing 855I reassignments to ICC, 855B practice locations, PECOS and NPPES updates, revalidations, and Medicare EFT and remittance setup.
Configure physician offices to submit ICC patient claims through ICC’s payer ID and confirm claims flow end to end.
Maintain the 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, lead brief onboarding sessions, and resolve claim submission problems.
Explain physician payment reports and how ICC payments relate to each physician’s own practice billing.
Review every claim before submission, checking CPT/HCPCS codes, modifiers, place of service, units, and diagnosis codes; approve, correct, or return claims as appropriate.
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, verify that documentation supports billed services, and track error rates by physician.
Use Nightingale’s HCC view to identify potentially undocumented conditions; send compliant, non-leading queries when records may support a condition, and code only what the physician documents.
Provide physicians and staff with specific coding feedback and escalate patterns to ICC physician leadership.
Post and reconcile Medicare remittances (835s), address rejections and denials, and file corrections, reopenings, and appeals.
Answer questions from physicians and office staff about claims, remittance status, and payment reports.
Reconcile Medicare payments to ICC with payments ICC makes to physicians or their practices.
Call each patient before the first ICC claim to explain how ICC will appear on Medicare statements and provide a contact for questions.
Respond to patient billing questions and resolve concerns, coordinating with physician offices as needed.
Screen rendering physicians and billing staff monthly against the OIG exclusion list and SAM.
Maintain 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 physician EMRs only for ICC patients and only to the extent needed for each task, in accordance with HIPAA.