Ophthalmic Consultants of Boston ยท 12 hours ago
Senior Revenue Cycle Manager
Plymouth, MA
Full-time
Onsite
Senior Level
5+ years expOphthalmic Consultants of Boston (OCB) seeks an experienced and detail-oriented Senior Revenue Cycle Manager to oversee and manage their healthcare organization's billing and claims processing operations. The role involves managing a high volume of claims processing, insurance denials, appeals, and contract management, while also leading a large team to ensure efficiency and compliance.
Health CareMedicalMedical Device
Responsibilities
Manage all aspects of the revenue cycle, including preparing, submitting, and following up on claims to insurance companies, government payers, and other third-party entities
Collaborate with physicians, insurance companies, and internal departments to resolve billing issues, ensure accurate coding, and improve revenue cycle performance
Ensure accurate medical coding in compliance with relevant standards (e.g., ICD-10, CPT)
Conduct regular chart audits to ensure documentation compliance and accuracy in billing practices
Proficiently understand and apply insurance plan coverages, benefits, and payer coverage policies to ensure accurate claims submission and reimbursement
Submit prior authorization requests to various insurance payers to ensure medical procedures, treatments, and services are covered under patient insurance plans
Oversee the processing of high claims volumes, ensuring timely and accurate submissions that align with payer requirements and contract terms
Review and resolve insurance denials, using in-depth knowledge of insurance coverage policies and benefits to appeal denials and recover revenue
Lead efforts in managing and appealing denied claims, ensuring claims are submitted with complete and accurate information in compliance with payer policies
Analyze and manage insurance contract terms to ensure billing and coding practices align with the terms, reimbursement structures, and payer coverage policies outlined in contracts
Develop strategies to reduce claim denials by enhancing knowledge of payer coverage guidelines and ensuring claims are submitted correctly the first time
Conduct audits on billing and claims submission processes to ensure compliance with payer guidelines and regulatory standards
Manage and mentor a team of billing specialists, and small team of experienced credentialing staff, providing ongoing training, support, and performance management to ensure high accuracy and efficiency
Develop and implement quality metrics and performance benchmarks for the billing team, focusing on key indicators such as claim submission accuracy, denial rates, and revenue cycle performance
Set clear expectations for staff performance and productivity, ensuring alignment with organizational goals and quality standards
Provide ongoing training for the billing team on insurance policies, payer coverage, claims processing, denial management, prior authorizations, and industry best practices
Monitor and assess team performance using key metrics, conduct regular performance reviews, identify areas for improvement, and implement corrective actions as needed
Prepare and present detailed reports on key performance metrics (KPIs) such as denial rates, claim submission accuracy, revenue cycle performance, and appeals outcomes
Ensure the team stays current with changes in payer coverage policies, insurance guidelines, and relevant healthcare regulations
Build and maintain strong relationships with insurance payers to ensure smooth claims resolution and address issues related to payer coverage policies and reimbursements
Qualification
Required
Bachelor's degree in healthcare administration, Business, Finance, or a related field
5+ years of experience in revenue cycle management, billing, and claims processing in a healthcare setting, with at least 3 years in management
Strong understanding of insurance plan coverages, benefits, payer coverage policies, and prior authorization requirements, with a demonstrated ability to apply this knowledge to claim processing and appeals
Extensive experience managing insurance denials, appeals, and negotiating with payers to resolve billing discrepancies
Proven experience managing and leading a large billing team, including training, performance management, and providing leadership in a fast-paced environment
Experience with contract management and understanding payer contracts, including reimbursement structures and coverage policies
Experience in the healthcare industry is required; experience in Ophthalmology or specialty practice management is strongly preferred
Proficiency in billing software, practice management systems, and electronic health record (EHR) systems
In-depth understanding of coding, billing procedures, and the revenue cycle from start to finish
Excellent problem-solving skills with the ability to analyze complex billing issues and develop practical solutions
Strong organizational skills and the ability to manage multiple priorities in a fast-paced environment
Familiarity with HIPAA regulations and compliance standards for patient confidentiality
Preferred
Certification in Medical Billing and Coding (e.g., CPC, CBCS) or Revenue Cycle Management (e.g., CHFP, CRCR)
Familiarity with Ophthalmology-specific billing and coding (e.g., CPT/ICD-10 codes related to Ophthalmology services)
Benefits
Medical & dental insurance (starts on the 1st day of employment!)
401(k) plan with Company match
Company paid Life Insurance
Company paid Long Term Disability
Eye care discounts
Generous Paid Time Off and Paid Holidays
Company
Ophthalmic Consultants of Boston
Ophthalmic Consultants of Boston is a medical practice specializing in eye care, laser and surgical treatment.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Suzanne McDermott
Chief Operating Officer
Ann Bajart
Partner
Recent News
Healthcare IT News
2024-05-23
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