Job Description
Job Description
Job Title : Manager, Revenue Cycle
Reports To : Chief Finance Officer (CFO)
Job Summary : Manages and supervises the activities of Revenue Office, and Credentialing Team, develops and maintains an internal Patient Billing Office and works directly with Revenue Analyst to improve processes and efficiencies in Revenue Cycle. Improves revenue department and the financial strength of CCHCI, ensures CCHCI's mission and strategic goals of leadership are included in decisions about revenue cycle management and as a manager familiarizes themselves with the 'big picture'. Asks questions and collaborates effectively under the guidance of the Revenue Director. On call for directors and chiefs and eagerly strives to participate in CCHCI management team efforts. Present as needed at board meetings and attend at least two board meetings per year.
Qualifications and Requirements :
The requirements listed below are representative of the knowledge, skill, and / or ability required. Job duties may be modified at any time based on business needs.
Essential Job Duties :
Manages office operations and revenue staff alongside the Revenue Supervisor and directs credentialing staff. Works daily with Revenue Analyst.
- Manages and oversees personnel including the planning for potential staff needs, writing job descriptions, recruiting, interviewing, training, evaluating, advising supervisors and other personnel to include revenue office supervisory staff, revenue analysts and credentialing team.
- Facilitates and leads revenue supervisor to provide education, operational training, hands-on coaching, and other staff development tools and resources for the revenue office.
- Leads credentialing team.
- Understands and continuously updates self-knowledge of credentialing including knowledge of HRSA rules and internal policies to lead our credentialing specialists to ensure effective and accurate documentation and delivery of provider credentialing, licensing, and privileging materials to credentialing committee.
- Works directly with outsourced credentialing teams to ensure delivery of essential information and certification of credentials in a timely fashion. Ensures backs up of all information.
- Updates, writes, or otherwise develops revenue and credentialing procedures and policies as determined by Revenue Director when necessary.
- Plans and conducts regular operational staff meetings effectively as well as regular meetings with direct reports.
- Engages in strategic planning activities and implements strategic decisions into operational plans.
- Attends and participates in leadership, management and meetings, and board meetings twice a year and runs and plans Continuous Quality Improvement meetings for other departments in the organization, and other staff meetings as needed.
- Directs, develops, and implements policies and procedures regarding business office and credentialing operations.
- Assists with various projects in support of Leadership.
- Ensures that Month End closings are completed in a timely and accurate manner.
- Expands and manages patient billing section using patient accounts representatives, RCAs and hires a financial counselor as needed to perform daily analysis and reconciliation of patient charges, overdue accounts, and communication with outsourced patient accounts as well as good patient communication.
- Patient Billing team to directly work with insurance enrollment team in case of financial hardship.
Assists in Maintaining Financial Strength of CCHCI
Identifies, analyses and addresses challenges and / or breakdowns in revenue cycle process. Works closely with Revenue Analyst to solve revenue issues using a data driven process.Plans and develops important changes using data analysis. Understands charts, tables, PDSA process and spreadsheets and communicates regularly with CCHCI informatics team.Gathers, creates, and reports accurate data to facilitate and support leadership requests, and internal and external audits as required with assistance of Revenue Analyst if necessary.Becomes proficient in EPM and EHR in Nextgen.Assists with contracted rates and works closely with Revenue Director, insurance contractors, analysts, and proprietary software to understand payment trends and correct reimbursement errors.Understands and regularly uses available KPIs from informatics, finance, Revenue Director, and outsourced agencies to address management needs and identify trends or issues.Collaborates closely with the Finance Department to contribute to cash reconciliation activities and in the assessment of accounts receivable collectability, including write-off of bad debts, etc.Performs ongoing trend analysis of payer rejection and denials and develops strategy for efficient prevention of these lapses in payment using available means such as charge editing software and streamlining of revenue processes.Assists and proposes fixes in system administration of NextGen by reviewing and editing billable service items and other menu items and templates that affect billing.Works alongside revenue analysts and OSIS during system upgrades, software additions and EDI issues to maximize practice management analysis and properties in Nextgen, etc.Reviews the End of Month balances of patient accounts receivable for accuracy through ongoing KPIs.Analyzes aging of patient accounts receivable monthly and directs billing staff to improve payment statuses using data-driven processes.Ensures that a plan for charges and payments to be posted daily is in place, as well as goals for timely entrance of all charges and unsubmitted encounters are out into action.Ensures personnel keeps Chargemaster and all charges and codes up to date and in accordance with FQHC requirements.Manages claim denials to identify causes, corrective actions and ensures timely resubmission and provides reports.Manages patient accounts regarding payment arrangements, collections and resolution of complaints and correction of errors.Works directly and professionally with outsourced AR and other vendors to increase efficiency of department.Conducts routine internal audits of charges, payments, and adjustments.Ensures unbilled encounters and un-submitted charges are addressed.Assists in negotiation and renegotiation of contracts.Reviews regularly, learns, and follows all internal CCHCI Revenue Policies and Procedures.Required Minimum Qualifications - Education, Experience, Certificates & Licenses :
High School diploma / GED and five years' management experience OR associate degree in applicable field and three years' management experience OR bachelor's degree in a related field and two years management experience.Driver's License and Proof of Insurance may be required if requesting mileage reimbursement.Preferred Education, Experience, Certificates & Licenses :
Master's degree in applicable field and more than five years of management experience in revenue cycle and / or finance.Experience working at a Federally Qualified Health Center.Proficiency with Microsoft products including Excel and PowerPoint.Required Language Skills :
Ability to comprehend and compose instructions, correspondence and communications in English at a college-educated level in both oral and written format.Ability to effectively present information in one-on-one and small group situations to patients, internal providers and staff and other agency staff working in cooperation with the organization.Physical Requirements :
Ability to occasionally exert enough force to move objects weighing up to 10 pounds.Ability to continuously remain in a stationary position.Ability to occasionally move about inside the workplace to access files, office machinery, etc.Possesses hand-eye coordination and manual dexterity necessary to constantly operate computer, telephone, and other office machinery.Possesses close visual acuity necessary to accurately record and view information on a computer monitor, handwritten and typed documents.Ability to discern the nature of sounds at a normal spoken volume.Other Required Knowledge, Skills, and Abilities :
Knowledge of the current health care market and FQHCs is necessary.Ability to communicate effectively as a leader and present information professionally including in a written report or slide presentation is essential.Ability to be a part of and create a team environment.Ability to add, subtract, multiply, and divide in all measure, using whole numbers, common fractions and decimals.Ability to compute rate, ratio, and percent and to create and interpret graphs, tables, spreadsheets, and charts is necessary.Demonstrated ability to skillfully gather and analyze data.Ability to perform a variety of assignments and make decisions requiring considerable independent judgment balanced by the ability to work professionally and collaboratively with leadership.Displays a high level of critical thinking and problem-solving skills.Displays sound and accurate judgment and ability to make timely decisions.Demonstrated ability to work in a fast-paced environment.Knowledge of billing, medical records, medical office operations, health plans, and community health centers required.Knowledge of HIPAA and Corporate Compliance rules and regulations.Knowledge of Human Resources Policies and procedures and Employee Handbook.Computer literacy is required with high proficiency in use of all Microsoft Office programs.Knowledge of Electronic Health Records.Ability to employ motivational techniques to train, mentor and lead staff.Demonstrated leadership skills with ability to build effective teams.Ability to prioritize and plan work, use time efficiently and develop realistic action plans and ensure project milestones are completed.Work Environment & Conditions :
Work environment is usually typical of an administrative office setting with no substantial exposure to adverse environmental conditions.Work requires reliable transportation as position requires frequent travel and extended hours to include early mornings, evenings, holidays, and weekends.Work requires the ability to be contacted by cell phone during or outside of regular work hours.
