Revenue Cycle Management Manager — U.S. Ophthalmology Practice

Company: Bespoke Ophthalmics
Position: Revenue Cycle Management (RCM) Manager
Location: Remote — India
Employment: Full-time
Schedule: Monday–Friday, 10:00 a.m.–6:00 p.m. U.S. Eastern Time
Shift: Night shift in India; occasional Saturday hours required as operationally necessary
Paid time off: Three weeks annually
Advantages: No additional employer-sponsored benefits

About Bespoke Ophthalmics

Bespoke Ophthalmics is = seeking an experienced, highly accountable RCM Manager to assume hands-on responsibility for our complete revenue cycle. This is a direct position with Bespoke Ophthalmics—not a multi-client billing-company or call-center role.

Position Summary

The RCM Manager will personally manage all billing activities for a small 1 doctor ophthalmology practice seeing <100 patients/week (3 full clinic days, 1 surgery day, 1 admin day).

This role has significant pre-existing staff support as detailed below:

- A general operations team is available FT to help with lower skill tasks such as eligibility and benefits verification and filing prior authorizations and Charge Posting.

- A chartered accountant is available to help with financial audits, f/u on problem claims, and general accounting tasks and report analysis.

- A highly experienced Practice Administrator is available FT to address any high level strategic or policy related enquiries.

- An IT dept is available to address any IT related concerns.

- Consultant Training from Nextech on EMR/PM software use is accessible as needed.

These supporting actors notwithstanding, the manager will retain full personal responsibility for these roles:

1. Training, supervising, and remaining accountable for the activities of the general operations team (which is comprised of educated workers who are not professional billers).

2. Taking full ownership of end to end RCM management.

3. Routinely meeting with practice leadership to reviewing billing performance and milestones.

4. Taking moral ownership of the billing functionality of the practice. This includes for example, cleaning up old AR, finding and re-billing denied claims or contesting denied CPTs, highlighting quality improvement issues with note composition by the doctor, and keeping abreast of updates and improvement to Nextech billing software as they become available.

This is a hands-on working-manager position. The successful candidate must be capable of independently reviewing claims, correcting billing and coding errors, resolving clearinghouse rejections, working complex denials, preparing appeals, identifying underpayments, and completing necessary follow-up without depending on another employee.

Essential Responsibilities

Team Leadership and Accountability

- Ensure every claim, denial, authorization, patient balance, and A/R account has a clearly assigned owner and next-action date.
- Cross-train team members and ensure adequate operational coverage.
- Create a culture of accountability, accuracy, and timely follow-through.

Hands-On Revenue-Cycle Management

The RCM Manager will personally complete or oversee all aspects of the revenue cycle, including:





- Charge capture and charge entry
- Ophthalmology-specific coding review
- CPT, ICD-10-CM, HCPCS, modifier, and laterality review
- Claim creation, scrubbing, and electronic submission
- Clearinghouse rejection review and correction
- Corrected claims and replacement claims
- Denial investigation and resolution
- Reconsiderations and formal appeals
- Complex and high-value A/R follow-up
- Medicare and commercial-payer correspondence
- Underpayment identification and recovery
- ERA and EOB interpretation
- Payment-posting quality control
- Credit balances, refunds, and unapplied payments
- Patient balances and billing escalations
- Coordination-of-benefits issues
- Timely-filing prevention and recovery
- Payer portal and clearinghouse management
- Credentialing and payer-enrollment coordination when necessary
- Reconciliation and revenue-leakage investigation
- Any other revenue-cycle function not assigned to a team member

Ophthalmology Billing and Coding

- Review billing and coding for ophthalmic examinations, diagnostic testing, office procedures, and surgery.
- Ensure appropriate use of ophthalmology-specific CPT and HCPCS codes, modifiers, laterality, diagnosis sequencing, and payer rules.
- Understand cataract surgery billing, global surgical periods, postoperative care, co-management, and related modifiers.
- Review billing for ophthalmic diagnostic testing and establish medical-necessity and documentation requirements.
- Manage claims involving intravitreal injections, J-codes, drug units, wastage, and NDC reporting when applicable.
- Identify coding or documentation deficiencies and communicate required corrections to clinical and administrative staff.
- Monitor Medicare and commercial-payer policies affecting ophthalmology reimbursement.

Denials, Appeals, and A/R Control

- Personally review complex, high-value, aged, or repeatedly denied claims.
- Determine whether each denial requires a corrected claim, reconsideration, reopening, formal appeal, documentation submission, or payer escalation.
- Prepare well-supported appeals using clinical documentation, coding guidance, payer policy, and medical-necessity criteria.
- Analyze denial patterns by payer, provider, procedure, diagnosis, modifier, employee, and root cause.
- Implement corrective actions that prevent recurring denials.
- Prioritize A/R according to age, value, timely-filing risk, appeal deadlines, and likelihood of recovery.
- Ensure payer calls include complete documentation, including the representative’s name, call reference number, outcome, and required next action.
- Prevent abandoned accounts, undocumented follow-up, and avoidable write-offs.
- Escalate high-value or high-risk accounts to practice leadership promptly.

Reporting and Performance Management





- Provide Bespoke leadership with a concise weekly performance report.
- Track and analyze metrics including:
- Clean-claim rate
- First-pass resolution rate
- Claim-submission turnaround time
- Clearinghouse rejection rate and aging
- Denial rate and leading denial causes
- Days in A/R
- A/R over 90, 120, and 180 days
- Untouched or inadequately worked A/R
- Net collection rate
- Payment-posting turnaround time
- Unposted and unapplied payments
- Underpayments and credit balances
- Appeal inventory, aging, and overturn rate
- Employee productivity and quality
- Preventable write-offs and revenue leakage
- Clearly distinguish activity and work volume from completed work and actual financial results.
- Identify negative trends before they cause significant revenue loss.
- Recommend staffing, training, workflow, or technology changes supported by data.

Required Qualifications

- At least five years of direct experience in U.S. medical billing and Revenue Cycle Management, particularly in ophthalmology billing and coding.
- ONLY CANDIDATES WHO HAVE PREVIOUSLY WORKED IN OPHTHALMOLOGY WILL BE CONSIDERED. APPLICANT EXPERIENCE MUST BE VERIFIABLE VIA MULTIPLE REFERENCES +/- LETTERS OF RECOMMENDATION.
- Professional spoken and written English .
- Stable high-speed internet, a private workspace, reliable power, and an appropriate computer setup. Webcam for Google Meet is required.

Preferred Qualifications

- CPC, CPB, CRCR, or comparable billing or coding certification.
- Experience with cataract surgery, premium IOLs, global surgical periods, and postoperative billing IS A REQUIREMENT.
- Experience with ophthalmic diagnostic testing, laterality, and modifier requirements.
- Experience with intravitreal medications, J-codes, drug units, wastage, and NDC reporting.

Schedule and Availability Requirements

- Work schedule is 10:00 a.m.–6:00 p.m. U.S. Eastern Time, Monday through Friday.
- Because the United States observes daylight-saving time, the corresponding working hours in India will change by one hour during the year.
- This is a night-shift position in India.
- Consistent availability throughout the scheduled shift is required.

Screen Sharing, Recording, and Daily Communication

As conditions of this remote management position, the successful candidate must:

- RCM Manager MUST BE AVAILABLE DURING WORK HOURS TO PARTICIPATE IN A RECURRING COMPANY WIDE GOOGLE MEET TO ANSWER QUESTIONS AS NEEDED.
- SCREEN SHARING IS A REQUIREMENT DURING WORKING HOURS.
- Remain reachable for real-time consultation with Bespoke Ophthalmics leadership during scheduled working hours.
- Consent to these requirements is a non-negotiable condition of accepting and maintaining the position. Candidates who are uncomfortable with daily video availability, screen sharing, or approved screen recording should not apply.

Compensation and Time Off

- Fixed annual salary: ₹17-19 LPA INR
- Paid time off: Three weeks per year
- PTO must be scheduled in advance and approved based on operational coverage, except in emergencies.
- No additional employer-sponsored benefits are offered.

Pay: ₹1,700,000.00 - ₹1,900,000.00 per year

Work Location: Remote

📌 Medical Billing Revenue Cycle Manager (India)
🏢 Bespoke Ophthalmics
📍 India