Manager, Managed Vision Care

What you'll do:

Who you are:

• Backed by 5+ years of experience in medical insurance billing and revenue cycle management
• A resourceful self-starter who is detail-oriented and thrives on managing tactical workflows and deadlines
• An analytical thinker with strong financial acumen
• Comfortable managing payment reconciliations, variance analyses, and the monthly accounting close cycle
• A process-oriented problem solver who can identify trends in claim denials to drive system improvements and develop comprehensive SOPs
• An expert at navigating complex stakeholder environments, with a proven track record of building consensus and driving cross-functional alignment
• A well-rounded communicator, collaborator, and presenter who can articulate a compelling vision and share actionable insights with everyone from engineers to executive leadership
• Not on the Office of Inspector General’s List of Excluded Individuals/Entities (LEIE)

Responsibilities

• Own the insurance revenue cycle: manage billing, claim, and reimbursement workflows to ensure timely payment
• Manage the reconciliation of carrier reimbursements
• Support the monthly accounting close cycle, including journal entries, schedule preparation, and variance analyses
• Partner with the Technology team on fee schedule set-ups and technical implementations
• Support execution through strategy development, testing, and documentation
• Oversee the day-to-day tactical work, including the quick resolution of exceptions related to claims submissions, front-end denials, and carrier adjudication
• Identify trends in claim exception reasons and recommend process improvements to reduce denial rates
• Manage the relationship with our claims clearinghouse and other vendors to ensure smooth data transmission
• Develop and maintain SOPs, protocols, and policies related to claims and payments
• Serve as the internal coding and claim expert to ensure compliance; identify fraud risks and take action to mitigate them
• Handle fee schedule maintenance and documentation to ensure accuracy across our systems
• Oversee the testing and maintenance of 837 (claims) automation
• Create reports and analyses to monitor the performance of insurance AR and support audits