Revenue Cycle Manager

Revenue Cycle Manager

Position Summary:

The Revenue Cycle Manager is responsible for supporting and monitoring the billing practices and processes to optimize all departmental revenue cycle activities. As such, the Revenue Cycle Manager ensures that billing, collections, and reimbursement operations run smoothly and efficiently. The ideal candidate will have a deep understanding of healthcare revenue cycle operations, financial analysis, team leadership, and a proven ability to implement strategies that improve revenue capture, reduce denials, and maximize collections. 

POSITION REQUIRMENTS: 

Bachelor’s Degree in related field is preferred.  Extensive experience and understanding of medical billing operations and medical insurance claims processes.  ICD-10 Certification is preferred. Minimum of one to three (1-3) years of supervisory experience.

RESPONSIBILITIES: 

Revenue Cycle Management:

Lead, manage, and optimize all aspects of the revenue cycle, including patient registration, charge capture, coding, billing, collections, and accounts receivable management.

Ensure compliance with all federal, state, and payer-specific regulations, as well as company policies related to billing and reimbursement.

Develop and implement best practices for timely and accurate billing, reducing errors, denials, and delays.

Staff Management and Development:

Supervise, train, and mentor a team of revenue cycle staff, including billing specialists and collections personnel.

Conduct regular performance evaluations and provide ongoing feedback and coaching to team members.

Ensure continuous education and training for the team to stay up-to-date on regulatory changes and industry best practices.

Denial Management and Analysis:

Oversee denial processes, working closely with payers, internal teams, and external vendors to ensure swift resolution.

Implement strategies to reduce claim denials and improve payer communication.

Track and analyze denial trends and make recommendations for process improvements to minimize future denials.

Financial Reporting and Analysis:

Develop and maintain key performance indicators (KPIs) for the revenue cycle team, including days in accounts receivable (AR), AR aging, claim denial rates, and collection percentages.

Provide regular reports to senior management on revenue cycle performance, highlighting areas of concern and offering actionable solutions.

Assist in the preparation of financial forecasts and budgeting related to revenue cycle operations.

Process Improvement:

Continuously assess and improve workflows, identifying opportunities for process automation and efficiency gains.

Collaborate with cross-functional teams (e.g., IT, clinical departments, vendors) to implement systems or changes that enhance the revenue cycle process.

Identify trends and areas for improvement and implement corrective actions as necessary

Compliance and Risk Management:

Ensure adherence to all industry regulations, including HIPAA, coding guidelines, billing practices, and payer contracts.

Stay informed of regulatory changes and make adjustments to policies and procedures accordingly to mitigate risk.

Patient Experience:

Ensure the revenue cycle process is patient-friendly, focusing on transparency, clarity, and timely resolution of billing inquiries.

Address patient complaints or concerns related to billing or insurance issues in a professional and empathetic manner.

Competencies and Skills

• Leadership & Team Management: Proven ability to lead and develop high- performing teams, fostering collaboration, accountability, and growth.

• Analytical & Problem-Solving Skills: Strong ability to analyze data, identify trends, and implement solutions to optimize revenue cycle performance.
• Communication Skills: Excellent verbal and written communication skills, with the ability to clearly explain complex billing and insurance concepts to diverse         audiences.
• Regulatory & Compliance Knowledge: In-depth understanding of healthcare regulations, including HIPAA, ICD-10, CPT, and payer-specific requirements.
• Process Improvement & Project Management: Experience leading initiatives to improve workflows, automate processes, and drive efficiency in revenue cycle          operations.
• Technological Proficiency: Skilled in using healthcare management software, EHR systems, and analytics tools (e.g., Excel). NextGen experience preferred.
• Customer Service Orientation: Focused on enhancing patient satisfaction by addressing billing inquiries and resolving issues promptly and empathetically.
• Detail-oriented & Organized: Meticulous attention to detail in managing complex billing data and deadlines while ensuring accuracy.
• Adaptability & Continuous Learning: Ability to adapt to changing regulations, technologies, and processes while pursuing ongoing professional development.

PHYSICAL DEMANDS:  

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand, walk, and talk or hear. The employee frequently is required to use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and climb or balance. The employee is occasionally required to sit and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.