[Hiring] Revenue Cycle Compliance Manager @Icon Health

Role Description

We are seeking a highly organized and detail-oriented Revenue Cycle Manager with deep expertise in 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.

• 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.

Qualifications

• 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.

Requirements

This position is REMOTE.

Pay Rate = $25/Hr

Important Notice: Protect Yourself from Recruitment Fraud

• Verified Communication: All official emails from our team will only come from an @iconhealthco.com email address.
• Live Interviews: We never hire based on text or chat alone. Our multi-stage interview process always involves several live conversations with our team members via phone and/or web conference.
• Your Privacy: We will never ask for sensitive financial information, home office equipment fees, or payment at any point during the hiring process.
• If you receive a suspicious request or an email from a different domain claiming to represent Icon Health, please do not engage.