Revenue Cycle Manager

Job Title: Revenue Cycle Specialist - Orthopedic Care Location: Remote Reports To: SVP, Clinical Services Who We Are Icon Health is a leading provider of value-based musculoskeletal (MSK) care, collaborating with payers and providers to enhance outcomes and experience for individuals. The company partners with health plans and risk-bearing providers to assume accountability for reduced total cost of care. By combining technology-enabled MSK providers with proactive care coordination and decision support services, Icon Health delivers multidisciplinary, evidence-based care. We founded Icon Health on the conviction that every patient should be genuinely delighted with their care experience. By prioritizing patient-centered practices, ensuring clear care goals across the entire clinical team, and placing clinicians at the heart of care delivery, we aim to transform a fragmented system into one that truly serves patients. Our model uses a team-based approach to care, integrating musculoskeletal expertise and primary care to achieve better patient outcomes. At Icon Health, we foster a culture that embraces bold thinking, rapid iteration, and practical problem-solving. We seek team members who relish challenging the status quo and thrive in vertically integrated roles-where ideas can swiftly move from concept to execution without layers of red tape. Above all, we value individuals who are eager to roll up their sleeves, tackle obstacles head-on, and create innovative solutions that improve the lives of our patients and our clinical partners. Who You Are We are seeking a highly organized and detail-oriented Revenue Cycle Manager with deep expertise with multi state telehealth and in-person claim submission, copays, payment posting, insurance guidelines, and revenue cycle workflows that ensure we are reimbursed accurately and on time. More importantly the right candidate has deep expertise in medicare and medicare advantage regulations surrounding telehealth practices and compliance End to End RCM Responsibilities include: Effectively manage the billings and collections process to ensure that all billing/claims submissions are accurate and submitted within 5 days of the patient date of service (DOS), and that the initial claim denial rate is less than 5% of monthly claim submissions (i.e. Clean Claim Rate of 95%). Effectively manage the payment postings process to ensure payments are accurately applied to patient accounts, and that payments received from the EOB are reconciled daily to bank account deposits. Unapplied payments at any point in time should be less than 5% of total payments received. Effectively manage outstanding Accounts Receivable Balances to minimize A/R aged greater than 90 days, and attain average A/R days below 40 days. Effectively manage the billing, collections, and coding staff (both in-house and outsourced) to ensure that company-wide objectives defined herein are achieved. Stay up to date on regulatory and compliance rules for Medicare and Medicare Advantage payers Track, analyze, and appeal payer claim denials through structured denial management workflows to recover lost revenue and identify systemic adjudication trends. Monitor payer contract performance and fee schedules to audit for underpayments and ensure accurate reimbursement according to negotiated terms. Calculate and collect up-front patient financial responsibility utilizing real-time eligibility tools. Reconcile underpayments against specific payer contract fee schedules, auditing high-reimbursement cases to ensure contractual rates for supplies, procedures, and instrumentation are paid in full. Ensure that all Reimbursements for medical services or supplies are provided to a qualified beneficiary, medically reasonable and necessary, performed by a qualified practitioner (within the scope of their practice) and coded accurately (procedures and diagnosis) in accordance with the documented medical record. Determine the root cause of billing errors and act to prevent any recurrence, retrain on coding practices as needed and review policies and procedures for clarity of expectations and requirements. Provide timely overpayment refunds to the payor in compliance with associated federal or state funded healthcare program payor requirements. Continuously enhance skills and knowledge in compliance coding and billing training to minimize potential risk of receiving improper payments. Participate in coding reviews and monitoring of coding practices. Regularly participate in internal audits to verify that billing updates have been properly integrated and adhered to across all claims and address discrepancies with corrective actions as needed. Stay up-to-date on coding, reimbursement, and regulatory changes to ensure accurate claims, compliance, and efficient revenue management. Ensure that collections and accounts receivable (AR) management processes adhere to federal and state regulations, safeguard patient information, and maintain financial integrity Maintain and enforce a billing and receivables framework that maintains compliance, ensures accurate reimbursement, protects patient privacy, and optimizes cash flow What You’ll Bring Degree, certificate, or diploma in medical billing, health information management, or healthcare administration preferred Completion of a medical billing training program preferred. Certified Professional Biller (CPB) a major plus. Exceptional communication skills to interact with patients, healthcare providers, and insurance companies Unmatched attention to detail to ensure claims are processed timely and correctly, and that payments are received. Ability to manage multiple tasks and prioritize effectively Ability to use multiple digital tools for billing, record keeping and patient care directive We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment based upon age, color, handicap or disability, ethnic or national origin, race, religion, religious creed, gender (including discrimination taking the form of sexual harassment), marital, parental or veteran status, sexual orientation, gender identity, or gender expression. This position is REMOTE #J-18808-Ljbffr Icon Health