Revenue Cycle Manager

Job Title: Revenue Cycle Manager (RCM)
Reports To: Practice Administrator
Classification: Exempt | Full-Time
Salary Range: $80,000 – $105,000 Exempt (commensurate with experience)
Location: Poway

Position Summary:
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.

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.

Other Duties as Assigned

• Take on additional responsibilities or special projects as directed by leadership to support the
  evolving needs of the practice.

Physical Demands:

• Frequent movement between clinic areas, including walking, standing, and occasional sitting for
  extended periods.


• Must be able to lift up to 15–20 pounds occasionally (e.g., training materials, laptop bag).
  Ability to work in a fast-paced clinical environment with frequent interruptions and multitasking.


• Vision requirements include the ability to view images on digital screens for prolonged periods with
  attention to detail.

Qualifications:

Ophthalmology – Retina revenue cycle experience required.

On-site in the Poway, CA office

• Bachelor’s degree, preferred.


• Nextech experience, preferred.


• 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.

Benefits:

• 401(k)


• 401(k) matching


• Dental insurance


• Employee assistance program


• Health insurance


• Life insurance


• Paid time off


• Tuition reimbursement


• Vision insurance

Note: The content of this job description is intended to provide a general overview of the job's key responsibilities and qualifications. Additional responsibilities may be assigned to meet practice needs.