Revenue Cycle Manager

Job description

### Job Description: Revenue Cycle Manager, Integrated Complex Care Associates ### About the role The Billing Manager is the first full-time hire for Integrated Complex Care Associates (ICC) and owns billing, provider enrollment, and billing compliance for the group. You will review and release every claim ICC sends to Medicare, enroll and support the physicians who join, and be the person physician offices and patients call with billing questions. ICC is a California physician group serving patients with complex health needs, led by each patient's own primary physician. Physicians across California join ICC while keeping their own practices, and ICC bills Medicare for that work under its own group TIN. ### What you'll do #### Enroll and onboard physicians • Own provider enrollment: each physician's 855I reassignment to ICC, ICC's 855B practice locations, PECOS and NPPES updates, revalidations, and Medicare EFT and remittance setup. • Set up each physician's office to submit ICC patients' claims through ICC's payer ID, and confirm the first claims flow end to end. • Keep ICC's provider roster current as physicians join or leave, including who each physician is paid through. Support physicians and their offices • Be the main billing contact for each physician's office: answer questions, run short onboarding sessions, and fix submission problems quickly. • Walk physicians through their payment reports and how ICC's payments relate to their own practice's billing. #### Review and release claims • Review every claim before it goes to Medicare. Claims arrive from each physician's own practice system through ICC's payer ID, and ICC's system fills in ICC's TIN, the rendering physician's NPI, and the service location in the Stedi billing portal. • Check each claim's CPT/HCPCS codes, modifiers, place of service, units, and diagnosis codes, then approve it, correct it, or send it back to the physician's office. • Release approved claims to Medicare (Noridian, Jurisdiction E) under ICC's TIN, and track every claim to payment or denial. #### Coding quality • Sample claims regularly against the physician's EMR of record (ICC patients only) to confirm the documentation supports what was billed, and track error rates by physician. • Use Nightingale's HCC view to spot conditions that may be undocumented. Where the record may support one, send the physician a compliant, non-leading query, and code only what the physician documents. • Give physicians and their staff short, specific coding feedback, and escalate patterns to ICC's physician leadership. #### Payments and denials • Post and reconcile Medicare remittances (835s), work rejections and denials, and file corrections, reopenings, and appeals. • Answer physicians' and office staff's questions about specific claims, remittance status, and payment reports. • Reconcile what Medicare pays ICC with what ICC pays each physician or physician's practice. #### Support patients • Call each patient before their first ICC claim goes out to explain how ICC's name will appear on their Medicare statements and whom to call with questions. • Answer patients' billing questions and resolve their concerns, working with the physician's office as needed. #### Run billing compliance • Screen every rendering physician and billing staff member monthly against the OIG exclusion list and SAM. • Maintain ICC's billing and coding policies, document audits, and report findings to ICC's physician leadership. • Identify, report, and return Medicare overpayments within the federal 60-day rule. • Use access to physicians' EMRs only for ICC patients and only as much as each task needs, under HIPAA. #### Reporting You'll be employed by Integrated Complex Care MSO LLC, which provides management services to ICC and handles your employment, pay, and day-to-day administration. For coding, billing, and compliance decisions, you'll work under the direction of ICC's physician leadership (Kaushik Patel, MD) and follow ICC's approved billing and coding policies. Questions about what a physician documented go to that physician, and the final say on how a service is billed rests with ICC. ### What you bring • 5+ years of Medicare Part B professional billing for physician groups, including claim review, denials, and appeals. • Hands-on Medicare provider enrollment: PECOS, 855I reassignments, 855B group enrollment, and revalidations. • A current coding credential: CPC or CPB (AAPC) or CCS-P (AHIMA). CRC (risk adjustment) preferred. • 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: submissions, rejections, and remittances (837P, 277CA, 835). • Billing compliance experience: audits, exclusion screening, overpayment refunds, and HIPAA. • Familiarity with Medicare ACO programs (MSSP, ACO REACH, or LEAD) a plus. • Clear, patient phone and writing skills with physicians, office staff, and older patients; Spanish a plus. • Comfort as a first hire: building processes from scratch and working independently. ### Location, pay, and logistics • Location: remote within California; you must live in California. Pacific time business hours, with occasional travel to physician offices around the state. • Pay: $95,000+ base salary, depending on experience and location. Full-time, exempt. • Benefits: [Savanna fill in Florence standard benefits] • Screening: offers are contingent on a background check after a conditional offer, an OIG and SAM exclusion check, and HIPAA training before system access. • Equal opportunity: Integrated Complex Care MSO LLC is an equal opportunity employer and considers qualified applicants with arrest and conviction records in line with the California Fair Chance Act.