Clinical Pathway Support Manager

Retina Consultants of America; United States; On-site; USD 104,000 - 137,000; Full time

Job summary

Retina Consultants of America seeks a Clinical Pathway Support Manager, a vital role in enhancing revenue cycle processes. The ideal candidate will possess strong expertise in retinal healthcare operations and payer reimbursement, guiding practices to improve compliance and efficiency. Join a leading provider in the quest to eradicate blindness and drive innovative healthcare solutions.

Qualifications

• Master’s degree (preferably Business or Healthcare Administration) required.
• Minimum of 5 years in revenue cycle leadership.
• Experience supporting corporate teams.

Responsibilities

• Manage RCM initiatives across multiple practices.
• Develop training for staff on payer policies and coding.
• Monitor and analyze payer policy changes nationwide.

Skills

Strong physician billing experience

Knowledge of provider credentialing processes

Strong organizational skills

Customer service skills

Interpersonal skills

Communication skills

Time management skills

Education

Master’s degree in Business or Healthcare Administration

Tools

Microsoft Office

EHR PM systems

RCM data reporting tools

Job description

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Operations and Integration Associate at Retina Consultants of America

Introduction

Retina Consultants of America is identifying and evaluating candidates for the position ofClinical Pathway Support Manager. This position will report to the Vice President of RCM Operations. The clinical pathway support manager role is a highly visible and challenging role that will help execute the vision of the company’s long-term and short-term strategy and become an integral member of a dynamic and experienced operational team.

Our Company

Retina Consultants of America (RCA) is bringing together national leaders in surgical and clinical retina care. This network comprises preeminent retina research specialists with the common goal of eradicating blindness caused by macular degeneration, diabetic retinopathy, and other retina diseases.

With over 2.3M annual patient visits, more than 300 physicians, and more than 270 locations, Retina Consultants of America (RCA) is the largest retina care provider in the nation.

Our Mission

Through RCA’s physician-centered practice management model, physicians continue to drive clinical care and practice culture, while benefiting from the business expertise, resources and share best practices.

RCA seeks to expand our mission by partnering with leading retina specialists who are passionate about delivering excellent patient care and participating in innovative research.

RCA has created a business model that enables retina specialists to retain autonomy and ownership, augmented by sharing best practices facilitated through the Medical Leadership Board and executive management support. Practices within the network will continue to drive all clinical decisions and remain highly involved in strategic operations.

Our Core Values

• Relentlessly Commit to our Patients, to the Practices We Serve and to Our Mission
• Embrace the Legacies of Our Partner Practices
• Strive for Continuous Improvement Through Education and Research
• Exude Compassion in All We Do

Position Overview

The Clinical Pathways Support Manager is responsible for staying informed about nationwide payer policies and reimbursement trends. They will manage and oversee revenue cycle management (RCM) initiatives across multiple practices within the platform. This role involves collaborating with key stakeholders, practice RCM leaders, and other departments to meet all project milestones and timelines. A successful Clinical Pathways Support Manager must possess strong expertise in retinal clinical care, payer reimbursement policies, and revenue cycle processes. They should be detail-oriented, accurate, accountable, and balanced and demonstrate sound business judgment while aligning with the company's objectives.

Essential Duties and Responsibilities

• Monitor and analyze payer policy changes nationwide, including coding updates, prior authorizations requirements, and reimbursements.
• Partners with RCA practices work to align treatment pathways with reimbursement strategies and ensure compliance with standards.
• Develop training sessions or educational materials for clinical and administrative staff on payor policies, documentation best practices, coding changes, and financial impacts.
• Provide revenue cycle management expertise for adoption of enterprise-wide initiatives and support acceleration of revenue uplift
• Compile, analyze, and report data regarding performance and trends across the platform
• Implement continuous improvements for policies, procedures, and processes to align with RCA “best practices”
• Maintain expertise in retina-specific coding and billing
• Ensure clinical documentation and billing practices align with Medicare, Medicaid, and commercial payer regulations.
• Work with compliance to proactively mitigate audit risk
• Work collaboratively with RCA’s accounting, data, and payor relations teams
• Any other project as determined by the VP of RCM Operations

Knowledge, Skills, Abilities

• Strong physician billing experience (ophthalmology/retina, a plus)
• Knowledgeable in provider credentialing processes
• Ability to direct and lead multiple projects concurrently
• Knowledgeable in defining approach and resource requirements for projects
• Strong organizational, customer service, interpersonal, facilitation, communication, and time management skills
• Outstanding poise in a fast-paced business environment
• Ability to work both independently and in a team setting
• Flexibility to travel as needed

Education and Experience

• Master’s degree (preference Business or Healthcare Administration) and/or 10 years of physician practice experience
• Minimum of 5 years’ experience in revenue cycle leadership position
• Experience in providing cross functional support of a corporate team
• Proficient in Microsoft Office (Excel, Word, PowerPoint)
• Proficient in Microsoft Outlook
• Experience and ability to navigate practice EHR PM systems and RCM/data reporting tools (NextGen, Nextech, Tableau, Viewgol experience, a plus)

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Information Technology

• Industries

  Hospitals and Health Care

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