Medical Billing Manager (Revenue Cycle - MSK) at VAIL-SUMMIT ORTHOPAEDICS PC

Grand Junction, Colorado, United States -

Full Time

Start Date

Immediate

Expiry Date

20 Jul, 26

Salary

90000.0

Posted On

21 Apr, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Revenue cycle management, Medical billing, Orthopedic billing, Vendor management, KPI analysis, Denial management, Coding oversight, Staff leadership, Process improvement, Compliance, Financial reporting, Charge capture, Insurance verification, Claims submission, Strategic planning, Physician practice management

Industry

Hospitals and Health Care

Description

Description JOB SUMMARY The Medical Billing Manager is responsible for the strategic oversight and performance of the Clinic’s Revenue Cycle Management (RCM) function, with a focus on orthopedic and musculoskeletal (MSK) services. This role requires a deep understanding of physician practice billing, key performance indicators (KPIs), payer dynamics, and the operational realities of a physician-owned group practice. This position provides leadership across a hybrid RCM model, managing both internal billing staff and an external RCM partner. The Manager ensures alignment, accountability, and performance across all parties to optimize financial outcomes. The role moves beyond transactional billing responsibilities and focuses on driving performance, accountability, and continuous improvement. This role is accountable for achieving measurable improvements in revenue cycle performance and ensuring alignment across internal teams and external partners. The Manager partners closely with leadership, physicians, and external vendors to optimize reimbursement, improve processes, and ensure alignment with organizational goals. The ideal candidate understands the balance between maximizing appropriate reimbursement, maintaining compliance, and recognizing the unique dynamics of a physician-owned practice, where clinical judgment and patient relationships may influence billing and collection strategies. Certified Professional Coder (CPC) or equivalent certification preferred, or demonstrated equivalent experience in coding oversight and auditing This is a full-time position, Monday through Friday from 8a - 5p with some variances. This position offers medical, dental, and vision benefits, employer-paid long-term disability, continuing education funds, paid holidays, potential monthly bonuses and employee discounts. This position is open until filled. THE DETAILS OF THE JOB ESSENTIAL DUTIES AND RESPONSIBILITIES RCM Oversight & Performance Lead and oversee all billing and collections operations across both internal staff and external RCM partner Develop, monitor, and own performance against key RCM KPIs, including but not limited to: Days in A/R Net Collection Rate (NCR) Denial Rate First Pass Resolution Rate (FPRR) Charge Lag / Lag Days Establish baseline targets and consistently drive performance towards industry benchmarks. Drive measurable improvement in these KPIs through process changes, team accountability, and vendor management. Demonstrated experience in coding oversight, auditing, and documentation improvement within a physician practice environment Hold both internal team members and external vendors accountable to performance expectations and service level agreements (SLAs) Identify trends, gaps, and opportunities, and implement process improvements to enhance overall revenue cycle performance Provide regular reporting and actionable insights to executive leadership External RCM Vendor Management Serve as the primary point of contact and relationship manager for the outsourced RCM company Establish clear expectations, KPIs, and accountability measures for vendor performance Conduct regular performance reviews and operational meetings with the vendor Ensure proper coordination between internal workflows and outsourced functions (e.g., charge capture, coding, follow-up, denials) Evaluate vendor performance and recommend changes or contract adjustments as needed Hold external RCM partner accountable to defined KPI targets and service level expectations, with regular performance reviews and corrective action plans when targets are not met. MSK & Physician Practice Expertise Apply deep understanding of orthopedic/MSK billing, including surgical case complexity, global periods, and payer nuances Partner with physicians and leadership to align billing practices with clinical workflows and business objectives Recognize and appropriately navigate the dynamics of a physician-owned practice, including situations where aggressive collections may not align with physician preferences or patient experience goals Billing Strategy & Optimization Ensure accurate and compliant coding and billing practices while optimizing reimbursement opportunities Balance compliance requirements with strategic billing practices to avoid both underbilling and unnecessary conservatism Oversee denial management strategy, including root cause analysis and corrective action plans Utilize KPI data and trend analysis to prioritize initiatives, allocate resources, and drive continuous improvement in revenue cycle performance. Cross-Functional Leadership Collaborate with clinical departments (providers, PT, imaging, DME, front desk) to improve charge capture and workflow efficiency Serve as a key liaison between billing, operations, leadership, and external RCM partners Lead training and education initiatives for staff and providers on billing practices and documentation requirements Team Leadership Lead training and education initiatives for staff and providers. Manage and develop internal billing staff while coordinating efforts with outsourced teams Transition team focus from task-based work to performance-driven outcomes Ensure appropriate staffing, workflow design, and role clarity within the billing function ACCOUNTABILITY AND DECISION-MAKING Actions may affect a work unit or area within a department. May contribute to business and operational decisions that affect the department or patients. The position has a direct impact on the services provided by the Company and is generally given instruction by the supervisor. Accountable for being knowledgeable and understanding of all aspects of the billing and coding staff duties to include: Entering patient demographics and insurance information Verifying patient eligibility and benefits for upfront collection on unmet deductibles and co-insurance Responsible for reviewing operative reports within three business days of procedure/surgery o Enter charges accurately according to insurance payers/contracts Submitting clean claims by attaching necessary documentation for payment Follow-up on electronic claims and paper claims Posting insurance payments to patient accounts Submit all secondary claims when necessary Refund money owed to patient or insurances Conducts self in a manner that reflects a positive representation of the company, and encourages others to do the same. Observes strict patient confidentiality in dealing with patients. Requirements WHAT IT TAKES TO DO THE JOB KNOWLEDGE, SKILLS AND ABILITIES Deep expertise in Revenue Cycle Management within a physician group practice, preferably orthopedics/MSK Strong understanding of RCM KPIs (Days in A/R, Net Collection Rate, Denial Rate, First Pass Resolution Rate, Lag Days) and demonstrated ability to translate these metrics into actionable performance improvement initiatives. Proven experience managing or working within a hybrid RCM model (in-house + outsourced/vendor) Strong vendor management skills, including holding external partners accountable to performance standards Advanced knowledge of Medicare, commercial payers, and reimbursement methodologies Strong understanding of CPT, ICD-10, global surgical billing, and payer-specific nuances Ability to balance compliance with revenue optimization, avoiding both over- and under-billing Understanding of the business and cultural dynamics of physician-owned practices Strong analytical, reporting, and problem-solving skills Leadership experience with ability to drive change and accountability EDUCATION, EXPERIENCE AND CERTIFICATES Associates degree, preferably in business administration or related field; Bachelor degree preferred. 7+ years of medical insurance/healthcare revenue cycle experience will be considered in lieu of the degree. Medical coding certification preferred Minimum of 3 years medical insurance/healthcare billing and collections experience in a medical practice health system, with a deep understanding of medical billing rules and regulations. Orthopaedic preferred. Two years supervisory or management experience required NOTICE This job description is not intended to be a comprehensive list of activities, duties or responsibilities for this job. The duties, expectations and actions listed for this role may change at any time with or without notice. EEO STATEMENT We believe diversity makes us stronger. Vail-Summit Orthopaedics & Neurosurgery provides equal employment opportunities to all employees and applicants without regard to sex, gender identity, sexual orientation, genetics, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

Responsibilities

The Medical Billing Manager oversees the clinic's revenue cycle management, balancing internal staff operations with external vendor performance. This role drives financial outcomes through KPI monitoring, process optimization, and cross-functional leadership within a physician-owned practice.