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Nightingale

Provides WoW guides, tutorials, and resources

Revenue Cycle Manager

Clinical Support & Patient AdministrationUpdated on Nov 7
Full-timeCalifornia, USA$95k - $100k /yr

About the Job

Requirements

  • At least 5 years of Medicare Part B professional billing for physician groups, including claim review, denials, and appeals.
  • Hands-on Medicare provider enrollment experience, including PECOS, 855I reassignments, 855B group enrollment, and revalidations.
  • A current coding credential: CPC or CPB from AAPC, or CCS-P from AHIMA.
  • Working knowledge of ICD-10-CM, CPT/HCPCS, modifiers, and documentation standards for HCC risk adjustment.
  • Claims management experience through a clearinghouse or billing portal, including submissions, rejections, and remittances (837P, 277CA, 835).
  • Billing compliance experience, including audits, exclusion screening, overpayment refunds, and HIPAA.
  • Must live in California and work Pacific Time business hours.
  • Must complete a background check after a conditional offer, an OIG and SAM exclusion check, and HIPAA training before system access.
  • Ability to communicate clearly with physicians, office staff, and older patients by phone and in writing.
  • Ability to build processes from scratch and work independently as a first hire.

Responsibilities

  • Own provider enrollment, including each physician's 855I reassignment to ICC, ICC's 855B practice locations, PECOS and NPPES updates, revalidations, and Medicare EFT and remittance setup.
  • Set up each physician's office to submit ICC patients' claims through ICC's payer ID and confirm the first claims flow end to end.
  • Keep ICC's provider roster current as physicians join or leave, including tracking who each physician is paid through.
  • Serve as the main billing contact for each physician's office, answer questions, run short onboarding sessions, and resolve submission problems quickly.
  • Explain payment reports to physicians and how ICC's payments relate to their own practice's billing.
  • Review every claim before it is sent to Medicare, checking CPT/HCPCS codes, modifiers, place of service, units, and diagnosis codes; approve, correct, or return claims to physician offices.
  • Release approved claims to Medicare under ICC's TIN and track each claim through payment or denial.
  • Regularly sample claims against the physician's EMR of record for ICC patients to confirm documentation supports billed services and track error rates by physician.
  • Use Nightingale's HCC view to identify potentially undocumented conditions, send compliant non-leading queries to physicians when records may support a condition, and code only what the physician documents.
  • Provide physicians and staff with specific coding feedback and escalate patterns to ICC's physician leadership.
  • Post and reconcile Medicare remittances (835s), work rejections and denials, and file corrections, reopenings, and appeals.
  • Answer physicians' and office staff's questions about claims, remittance status, and payment reports.
  • Reconcile Medicare payments to ICC with payments ICC makes to each physician or physician's practice.
  • Call each patient before their first ICC claim is sent to explain how ICC's name will appear on Medicare statements and whom to contact with questions.
  • Answer patients' billing questions and resolve their concerns, working with physician offices as needed.
  • Screen every rendering physician and billing staff member monthly against the OIG exclusion list and SAM.
  • Maintain ICC's billing and coding policies, document audits, and report findings to ICC's physician leadership.
  • Identify, report, and return Medicare overpayments within the federal 60-day rule.
  • Access physicians' EMRs only for ICC patients and only to the extent needed for each task, in accordance with HIPAA.

Desired Qualifications

  • CRC (risk adjustment) credential preferred.
  • Familiarity with Medicare ACO programs, such as MSSP, ACO REACH, or LEAD, is a plus.
  • Spanish language ability is a plus.

About the Company

Nightingale

Provides WoW guides, tutorials, and resources

Nightingale creates in-depth guides and articles for World of Warcraft players. It covers PvP talents, PvE proficiency, gold farming, dungeon key management, and other game aspects to help players improve their gameplay. The site publishes expert-written content from seasoned WoW players and gaming journalists, and supports multiple revenue streams including advertising, affiliate marketing, and premium subscriptions. Its product works by offering long-form, strategy-focused articles and guides that players can read online; premium content provides additional, exclusive material for subscribers. Nightingale differentiates itself through its team of experienced players and journalists who deliver practical, up-to-date insights tailored to both veterans and new players, rather than generic gaming content. The company’s goal is to help WoW players maximize their in-game performance and enjoyment while sustaining revenue through ads, affiliates, and premium content.

Company size
11-50
Company stage
Seed
Total funding
$790K
Headquarters
San Francisco, CA
Founded
2013

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