Revenue Cycle Lead & Billing SME (RTM/CCM/PCM)

Alt; New York (NY); Sur place; USD 90 000 - 100 000; Plein temps

Résumé du poste

Flagler Health is building the clinical operating system for modern musculoskeletal care and seeks a player-coach revenue cycle leader to run care management billing hands-on today. You will supervise a small team of billers, own collections across partner practices, and guide RTM/CCM/PCM coding, billing, and payment.

The role emphasizes reconciliation, denial resolution, and process improvements across multiple EHR/PM systems with regular audits and client billing support.

Qualifications

• 5+ years of hands-on revenue cycle experience in physician practice or ambulatory billing, including A/R follow-up, denial management, and payment reconciliation
• 2+ years leading or supervising billers, coders, or a denials team
• Working knowledge of CPT and ICD-10-CM coding guidelines, ideally for care management codes (RTM, CCM, PCM)
• Experience with Medicare, Medicare Advantage, and commercial payers, including working directly with payer representatives
• Experience across multiple EHR and practice management systems
• Strong spreadsheet skills (pivot tables, lookups) for claim-level analysis
• Clear written communication; comfortable writing SOPs and presenting findings to clients and leadership

Responsabilités

• Owns charge and payment reconciliation. Reconciles billed services against posted charges, payments, and adjustments for every new partner practice, establishing the clean baseline that all collections analysis depends on.
• Runs monthly claim-level payment analysis. Pulls charge, payment, and adjustment reports from partner practice management systems, breaks them down by date of service, payer, program, and CPT code, and flags claims that are unpaid, underpaid, denied, or adjusted off in error. Sets the thresholds that trigger a full account review and owns each flagged account through resolution.
• Leads payer follow-up and denial resolution. Researches denial and underpayment patterns, contacts payers directly to find root cause, and recommends corrective action (rebills, appeals, coding or front-end fixes) rather than one-off workarounds.
• Oversees claim entry and corrections. Ensures claims are entered accurately and on time across multiple EHR and practice management systems, including self-pay charges and client-requested claim holds, and corrects errors partner practices send back.
• Manages a team of billers and contractors. Assigns claim entry, account reviews, and denial work across the team, sets priorities, and tracks throughput against deadlines.
• Runs the team's operating cadence. Holds regular denials and billing team meetings to resolve open questions, align on coding rules, and standardize how work is documented; holds recurring one-on-ones with each team member.
• Measures and audits quality. Produces monthly productivity reporting, runs sample-based audits of claim entry and account reviews, and coaches to close gaps.
• Reviews claims for coding compliance. Runs cross-practice reviews against ICD-10-CM guidelines (for example, excludes code pairs and diagnosis sequencing) and CPT rules for care management services, and presents findings to the team and leadership.
• Builds coding reference materials. Creates and maintains diagnosis pairing guides and program-specific coding tip sheets that billers and clinical staff use day to day.
• Writes and maintains SOPs. Documents claim entry and billing workflows for each practice management system the team works in, validates them with the people doing the work, and keeps them current as payer and client requirements change.
• Leads billing implementation for new partner practices. Walks new partners through how RTM, CCM, and PCM billing works, how to configure EHR templates for documentation compliance, and how billing data should flow, and confirms who owns claim entry at each site before go-live.
• Serves as the billing escalation point for active practices. Holds standing billing and collections calls with a subset of accounts, answers billing questions routed through customer success, and resolves issues across the rest of the book.
• Routes feedback upstream. Shares denial and underpayment patterns with clinical operations and customer success so recurring issues are fixed at the source instead of reworked downstream.
• Redesigns processes. Proposes and implements changes that simplify billing workflows, improve accuracy, and shorten time to collection.
• Partners with engineering. Hands off coding and billing rules as clear requirements, tests the resulting tools, and applies automation to reconciliation, denial triage, and collections follow-up.
• Strengthens front-end eligibility. Shares data and best practices to improve eligibility checks, benefits verification, and patient enrollment logic so fewer claims fail downstream.

Connaissances

Revenue cycle

Team leadership

CPT/ICD-10-CM coding

Payer relations

EHR/PM systems

Data analysis (pivot tables)

SOP writing

Description du poste

Flagler Health is building the clinical operating system for modern musculoskeletal care and seeks a player-coach revenue cycle leader to run care management billing hands-on today. You will supervise a small team of billers, own collections across partner practices, and guide RTM/CCM/PCM coding, billing, and payment.

The role emphasizes reconciliation, denial resolution, and process improvements across multiple EHR/PM systems with regular audits and client billing support.