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Ophthalmic Consultants of Boston (OCB)seeks an experienced and detail-oriented Revenue Cycle Billing Manager to oversee and manage our healthcare organization's billing and claims processing operations. This role handles a high volume of claims processing, insurance denials, appeals, contract management, prior authorization submissions, and managing a large team. This position is full time Monday through Friday 8-4:30PM.

Key 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.

+ 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 large team of billing specialists, 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.

+ Collaborate with physicians, insurance companies, and internal departments to resolve billing issues, ensure accurate coding, and improve revenue cycle performance.

Qualifications:

+ Bachelor’s degree in healthcare administration, Business, Finance, or a related field (preferred).

+ 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 Skills:

+ 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).

OCB offers industry leading benefits including:

+ 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

To learn more about OCB, please visit our website at www.eyeboston.com

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