Revenue Cycle Manager

Job Description

Job Description : \n\nThe revenue cycle is defined as all administrative and clinical functions that contribute to the capture, management and collection of patient service revenue. The Revenue Cycle Manager is responsible for implementing, maintaining and continuously improving an efficient and effective revenue cycle process through direct management of Admissions, Charge Capture, Coding, Billing and Collections, as well as working collaboratively with those clinical and administrative departments which generate revenue and / or impact the revenue cycle. Critical responsibilities include achievement of annual and periodic goals for significant statistical indicators of revenue cycle performance and for the organization’s overall financial success. The Revenue Cycle Manager is expected to demonstrate through plans and actions that there is a consistent standard of excellence to which all departmental work is expected to conform. Such a standard should be characterized by a focus on continuous quality improvement and the highest degree of customer service. The expertise of the Revenue Cycle Manager should include : Working knowledge in the areas of patient registration, billing, accounts receivable and cash management, health information management, managed care contractual terms and requirements, health insurance practices, industry regulatory requirements and compliance, business office operations, AR and financial reporting, basic accounting and industry standards for healthcare revenue resolution management practices.Ability to analyze and resolve problems that affect charge capture, claim submission and collection processes, regardless of whether the problem originates in an area under direct or indirect control.Financial management skills, including the ability to financially analyze data for operations, budgeting, auditing, forecasting, staffing and financial management skills.Leadership skills to motivate direct responsibility departments and cross-department teams’ performance towards excellence and develop team concepts and consensus building management styles.The ability to make a significant contribution to the organization’s overall effectiveness. ESSENTIAL DUTIES AND COMPETENCIES : Incorporate the organization’s mission, vision and values in all business practices and departmentally directed activities.Direct management responsibility for outpatient admissions, centralized scheduling, health information management, coding, charge processing, patient billing, claims submission, follow-up, cash receipt processing, and collections. Monitors, staffs and supports daily staff functions in all areas related to this scope of responsibility.Oversees functional Revenue Cycle Committee and organizes cross departmental work teams to address issues related to denial management, revenue maximization, revenue cycle enhancement and access management, so as to produce measurable results.Maintains appropriate internal control safeguards over AR records, cash collection and segregation of duties.Develops and maintains departmental compliance plan to ensure integrity in charge, billing and collection processes, complying with regulatory requirements of government and other third party payers.Sets goals for department financial and operational performance relative to admission accuracy, cash collection, days in AR, receivables levels and follow-up. Strives to meet goals by motivating and engaging a committed staff team.Assess and respond to internal and external customers’ needs with innovative programs to ensure excellent customer service and satisfaction.Ensure quality and consistency in all forms of patient financial communication.Oversees the financial interface and performance analysis of the patient financial services functions and fiscal services functions. Maintains effective communication between PFS and Fiscal departments.Maintains excellent understanding of automated systems for charge capture, billing, and electronic claims. Troubleshoots system problems, working with IT analysts as needed. Measures quality of billing processes by monitoring claim rejections, requests for information and denials. Ensures quality of the capture of patient billing information through the admissions process and resolves related issues.Oversees the financial and clinical interface, working collaboratively with clinical managers to develop and maintain charge masters, charge processes and appropriate authorization workflow. Monitors and ensures revenue integrity.Develops annual departmental operating plan, operating budget and capital budget and monitors achievement of associated goals. Participates in strategic planning and assessment / development of new programs.Recommends, develops and consistently administers financial service policies, Financial Assistance and other programs, clearly communicating them to staff and other stakeholders.Receives and resolves complaints from patients and others regarding all aspects of department operations in a timely manner. Reports results of process through proper channels. Promotes and administers service recovery as appropriate. Works with collection agencies and other third party contractors to ensure that contract terms are respected and CFVH patients / guarantors are treated consistently and equitably by all parties to the collection process.Maintains and ensures a departmental atmosphere that enhances staff development and excellence, including continuing education and development of career tracks and management succession plans.Participates at the state level in Healthcare Financial Management Association and MHIMA education, activities and collaboration, networking with other organizations, payers, state and federal agencies.Exhibits clear understanding and responsibility for maintaining patient confidentiality in all aspects of department operations.Coordinates relevant payer, independent and other audit responses for the organization. HIM-Specific Responsibilities : Oversees all of the Health Information Management functions in the organization, supervising all staff in the department, including coders and records clerks.Responsible for compilation of census reports and ensures the quality of daily and periodic census data, as well as associated statistical reporting to government and other agencies as required.Develops and implements policies and procedures for documenting, storing and retrieving health information, and for processing medical and legal documents, insurance data, and correspondence requests, in conformance with federal and state statutes.Acts as a resource to providers and clinical staff concerning clinical documentation and record integrity.Participates in development and design of computer software for computerized health information systemDevelops, disseminates and enforces policies and procedures related to integrity and security of health information ADM / Centralized Scheduling-Specific Responsibilities : Oversees & ensures quality of house-wide Admission / Registration procedures and data as an inflow to the revenue cycle processOversees & ensures quality of Centralized Scheduling operations to provide ease of access to hospital services and efficiency for depts. servedMonitors pre-authorization process with insurance companies and patient financial communication in advance of scheduling services to prevent denials and ensure patients’ understanding of their financial obligations for services received.Works collaboratively with department managers to resolve issues related to quality and efficiency of admissions & scheduling processes CORE COMPETENCIESQuality : Supports improvement and innovation in the workplace. Demonstrates awareness of and supports CFVH departmental and operating unit goals through participation in quality improvement, leadership and departmental activities. Strives for precision, efficiency, and accuracy in all aspects of operations. Seeks and utilizes feedback to improve performance.Job Knowledge : Specific patient financial services knowledge and skills; ability and motivation to learn; keeps abreast of current developments in the industry; understands how job / role relates to others; utilizes resources efficiently.Communication : Establishes and maintains open communication to enhance team effort and effectiveness; presents a positive image of department and organization to patients, physicians, visitors, fellow employees, vendors and the general public; verbal and writing ability, good listening, keeps others informed.Problem solving : Teamwork; takes initiative to identify and solve problems in a timely manner; analyzes information and develops alternative solutions; works well with groups.Initiative : Makes continuous effort to identify opportunities to meet / exceed customer needs and expectations. Seeks increased responsibility; volunteers readily; takes individual actions and calculated risks; requests for help when needed.Adaptability : Demonstrates flexibility in response to unexpected changes in workload, staffing and scheduling; meets challenges in a proactive manner; accepts constructive criticism and feedback; manages competing demands and priorities; changes approach or method to best fit the situation.Judgment : Makes decisions in a timely manner. Exhibits a sound, accurate judgment; supports others on the management team and clearly communicates rationale for decisions.Cost Consciousness : Promotes efficiency and cost effectiveness through the proper use and conservation of supplies and equipment; identify cost saving measures; ensure that department operations work to enhance the organization’s financial performance.Cooperation : Establishes effective relationships; looks for opportunities to assist co-workers; works collaboratively with all hospital departments, exhibits positive outlook and pleasant manner; resolves conflicts; role model for staff.Dependability : Fulfills work schedule and commitments; follows instructions; takes responsibility for own actions; commits to doing best job possible; attentiveness to attendance policies, punctuality and work schedule.Safety : Works in a safe manner; maintains a safe and clean work environment; reports needed repairs or potential hazards to the appropriate departments as soon as identified; ensures prompt reporting of work injuries.Confidentiality : Holds in trust the confidences of others, particularly patients; exhibits behaviors which protect the privacy of patients, physicians and employees.Corporate Compliance : Maintains awareness of, develops an understanding of, and adheres to all compliance program requirements; monitors compliance through audits and annual work plan, reports results and takes corresponding action as required.Planning and Organization : The ability to prepare for emerging needs, manage multiple projects, determine project priority / urgency, delegate effectively. Uses goals to guide actions and create detailed action plans, organize and schedule people and tasks.Leadership : The ability to communicate the hospital mission, vision and values to make adaptive responses. Assumes a role of authority as necessary; advocates new ideas, even when risk is involved; sets an example for co-workers and staff; delegates responsibility and empowers staff and co-workers to make decisions; provides constructive feedback to others.Management : The ability to establish relationships with and influence others whose cooperation is needed for the organization to succeed. Understands and values the input of diverse stakeholders. Shares information; participatively solicits co-workers’ ideas, fosters employee development, provides coaching feedback, expresses positive expectations of subordinates and rewards performance improvement.Systems : Ability to analyze operational systems and identify opportunities for improving their effectiveness, utilizing various tools and IT resources, work with cross-departmental / functional teams to address system issues and improve financial performance. SUPERVISORY RESPONSIBILITIES : Directly supervises Business Office staff (11); Admissions / centralized scheduling (2), HIM (5), including 3 leads. Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring and training employees, planning, assigning and directing work; appraising performance on a timely and consistent basis, rewarding and disciplining employees; addressing complaints and resolving problems. EDUCATION AND / OR EXPERIENCE : Bachelors degree in business, management or related field. A minimum of 5 years management / supervisory experience in healthcare business and receivables field required, with a work record that demonstrates : In-depth knowledge of hospital and physician billing and reimbursement, CAH & RHCOrientation to industry standards and emerging issuesLeadership in the core values of the organizationClear, effective communication skillsA mature approach to problem solving for all types of issuesSkills in maintaining and utilizing IT resourcesTeam-building, motivation and effective management of staffing resourcesNegotiating skillsDetail orientationExperience with Performance Improvement concepts and skillsKnowledge of healthcare industry financial statistical benchmarks COMPUTER SKILLS Applicants with knowledge and experience with the EPIC Electronic Health Record System will receive preference. Ability to comprehend system design and corresponding impacts on revenue cycle operations, utilizing analytical ability and consistent, organized approach to system application. Proficiency in the use of Microsoft Office applications, including Excel, Access, and Word. LANGUAGE SKILLS Ability to read, analyze and interpret general business, periodicals, professional journals, technical procedures or governmental regulations. Ability to write reports, business correspondence, policies and procedures. Ability to effectively present information and respond to questions from groups of people. MATHEMATICAL SKILLS Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations. REASONING ABILITY Ability to define problems, collect data, establish facts and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathemati9cal or diagram form and deal with several abstract and concrete variables. CERTIFICATES, LICENSES, REGISTRATIONS None required. Various applicable certifications (EPIC, CPAM, CHFP, RHIT, ART or other HIM certification) will receive appropriate preference and for the candidate lacking certification, support will be provided to attain mutually agreed certification(s). PHYSICAL DEMANDS The physical demands described here are representative of t