*Work Style: Remote, Hybrid or In-Person; ideal candidate would reside in NYS*
**While this role may be performed remotely, some benefits offerings (such as health insurance) are subject to regional eligibility requirements and may require residency in the Capital Region of New York State.
Position Summary
The Revenue Cycle Billing Manager is responsible for overseeing and optimizing the entire revenue cycle process across all Perlmutter Eye Center and Perlmutter Dermatology locations. This includes leadership of billing operations, payer relations, credentialing, maintenance of fee schedules, and ensuring maximum reimbursement for services provided.
Key Responsibilities
Leadership & Oversight
- Lead, manage, and mentor the billing and revenue cycle team, including billers, coders, and A/R specialists across multiple sites.
- Ensure accountability, training, and performance management within the billing department.
- Ensure timely and accurate processing of claims, payments, adjustments, and appeals.
- Establish performance goals, monitor KPIs (e.g., days in A/R, denial rate, clean claims rate), and implement improvement strategies.
- Organize team with centralized workflows using company provided software and cloud based organizational technology
Revenue Cycle Management
- Oversee the full revenue cycle from patient intake through final account resolution for clinic and ASC services.
- Oversee the full revenue cycle process including patient registration accuracy, insurance verification, prior authorizations, coding, charge entry, clean claim submissions, payment posting, and follow-up.
- Develop and maintain workflows that support best practices in ophthalmology & dermatology revenue cycle operations.
- Monitor KPIs such as days in A/R, denial rates, and collection rates, and implement corrective actions where needed.
Credentialing & Payer Enrollment
- Manage provider credentialing and re-credentialing for all payers, including commercial insurers, Medicare, Medicaid, and vision plans and keep records up to date
- Ensure all providers are accurately enrolled and active with payer systems to avoid delays in reimbursement.
Fee Schedule & Contract Management
- Maintain and regularly update fee schedules to ensure alignment with payer contracts and reimbursement expectations.
- Monitor contracted rates and reimbursement trends; analyze variances and recommend adjustments.
- Collaborate with leadership on payer contract negotiations and fee schedule reviews.
Insurer Relations
- Serve as the primary contact for payer relations and disputes.
- Resolve complex claims issues and escalated denials through direct communication with payers.
- Stay abreast of payer policy changes, reimbursement trends, and regulatory updates affecting ophthalmology.
Compliance & Coding
- Ensure compliance with HIPAA, CMS, and all applicable state/federal regulations.
- Supervise accurate CPT, ICD-10, and HCPCS coding for ophthalmology and ASC procedures including retina injections, cataract surgery, glaucoma treatments, and diagnostic testing.
- Stay current with ophthalmology & dermatology coding updates, NCCI edits, and payer policy changes.
Collaboration & Communication
- Work closely with physicians, clinical teams, schedulers, and front desk staff to ensure clean claims and smooth patient financial processes.
- Liaise with external vendors, payers, and clearinghouses to troubleshoot issues and optimize billing workflows.
Technology & Systems
- Manage and optimize the use of Modernizing Medicine, the practice’s EHR and PM system.
- Recommend and implement system enhancements to improve billing accuracy and revenue cycle performance.
Qualifications
Required:
- Minimum 5 years of experience in medical billing and coding, preferably ophthalmology, with at least 3 years in a managerial or supervisory role.
- Expertise in ophthalmic procedures and surgical billing, including retina, cataract, glaucoma, and ASC services.
- Strong knowledge of medical billing regulations, payor guidelines, and insurance processes.
- Experience with ophthalmology-specific EHR and practice management systems.
- Experience with ‘buy and bill’ drug transactions, workflows, and operations.
Preferred:
- Certified Professional Coder (CPC) or Certified Ophthalmic Executive (COE) credentials.
- Experience with multi-site practice operations.
- Proficiency in analytics/reporting tools to evaluate RCM performance.
Job Type: Full-time
Pay: $70,000.00 - $80,000.00 per year
Benefits:
- 401(k) matching
- Dental insurance
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Paid time off
Application Question(s):
- Do you have expertise in ophthalmic procedures and surgical billing, including retina, cataract, glaucoma, and ASC services?
- Do you have experience with 'buy and bill' drug transactions, workflows and operations?
- Do you have experience with ophthalmology-specific EHR and practice management systems?
- While this role may be performed remotely, at this time some benefits offerings (such as health insurance) are subject to regional eligibility requirements and may require residency in the Capital Region of New York State. Do you currently reside in NY? If not, in what state would you be working from?
Experience:
- Medical Billing & Coding: 5 years (Required)
- Managerial/Supervisory: 3 years (Required)
Work Location: Remote
