Revenue Cycle Manager

Description

 Want a better job? You have a lot of reasons to apply with us:

• We offer daytime hours and a steady work schedule. Be home for dinner.
• Modern offices; friendly people!
• We offer health insurance at $0 cost for employees, plus free dental coverage!
• Generous Paid Time Off, plus an ability to flex your time around appointments and personal commitments.
• Remote work on a hybrid schedule - the best of both worlds.
• This position is on our Administrative Team, giving you a seat at the table to direct our processes.
• We have a passion for providing the highest quality healthcare to our patients and their families, and a strong reputation for being a great place to work. Join us!

WHO WE ARE:

Complete Children’s Health is Lincoln’s most innovative pediatric practice. We are all about collaboration, teamwork, and excellent patient service. We are more than 130 employees strong, across four locations and love serving Lincoln's smallest residents and their families.

THE OPPORTUNITY:

Under the direction of the Practice Administrator, the Revenue Cycle Manager is responsible for leading and optimizing the back-office operations of the revenue cycle. This role ensures the financial health of the practice by developing and implementing strategies that maximize revenue capture, improve billing efficiency, and enhance payer relationships. The Revenue Cycle Manager analyzes revenue trends, identifies opportunities for process improvement, and collaborates with clinical and administrative teams to align billing practices with value-based care initiatives. Additionally, this individual provides leadership and mentorship to the Billing and Coding team, and works closely with quality management ensuring adherence to best practices, compliance with regulations, and continuous performance improvement.  

ESSENTIAL JOB FUNCTIONS: (A position may not be assigned all duties listed, nor do listed examples include all duties that will be assigned.)

• Commits to the mission and vision of CCH and consistently demonstrates our core values. 
• Leads the back-office operations of revenue cycle management, coding, submitting claims, addressing denials, overseeing collections, etc. while ensuring adherence to best practices and high standards of service
• Partners with the Front Office Team Leader to ensure the front office operations facilitate efficient billing practices; collaborates with other departments to resolve problems or improve processes as needed
• Integrates value-based care models into the billing and revenue cycle strategies to optimize performance, ensure compliance with quality metrics, and maximize reimbursement for value-based contracts
• Reviews data reports to understand trends in denials, charges billed, reimbursement collections, etc. looking for trends within the revenue cycle 
• Understands nuance of insurance contracts/relationships with payers and positions CCH providers to best take advantage of payer offerings
• Works in conjunction with Practice Administrator to develop a working knowledge of potential risk sharing relationships and positions practice to best take advantage of available offerings
• Understands quality measurements and works with care coordinator to ensure synchronized effort in achieving best possible financial results for the practice
• Understands current coding practice to allow potential for greatest possible reimbursement, ensures accurate coding and billing practices are followed, working with coding and clinical teams to resolve issues as they arise
• Regularly monitors fee schedules to ensure maximum reimbursement under current contractual relationships
• Plans and directs insurance submission, patient billing and collections/data processing to ensure accurate patient billing and account collections
• Oversees status of patient accounts, assists in identifying and resolving billing, collection and payment processing difficulties
• Supervises assigned personnel; assists in training, orientation and performance evaluation; recommends compensation increases, promotions, and disciplinary actions
• Establishes and recommends credit and collection policies
• Monitors daily operating activity of Billing Office, makes necessary adjustments to work assignments to ensure efficiency
• Maintains knowledge of and complies with established policies and procedures, including government, insurance and third-party payer regulations
• Works with vendors in selecting, implementing and converting system-wide billing and accounts receivable systems
• Maintains patient confidentiality and follows HIPAA guidelines
• Other duties as assigned

Requirements

Knowledge of: Healthcare regulations, including HIPAA, CMS, payer-specific requirements, and value-based care models; billing practices and procedures; coding and clinic operating policies and procedures including familiarity with ICD-10, CPT, and HCPCS codes; ethical and respectful customer service practices; administrative and clerical procedures; billing software, as well as Microsoft applications; principles and practices of supervision and management; leadership techniques; coordination of resources and employees; appropriate curriculum and training procedures. 

Skills in: Oral and written professional communication; interpersonal communication; time management; using computers and calculators; reading and understanding billing documents; active listening; critical thinking; problem solving; allocation of resources.

Ability to: Manage multiple priorities in a fast-paced, deadline-driven environment; examine documents for accuracy and completion; pay close attention to detail; work effectively with patients, families/guardians, staff, and the public; work both independently and in a team environment; maintain patient confidentiality; abide by HIPAA guidelines. 

MINIMUM REQUIREMENTS:

Bachelor’s degree required, degree in Business Administration, Finance, Healthcare Administration, or a related field is preferred. Five years of billing/revenue experience in a health care organization is required, with at least 2 years in a leadership role.

Complete Children’s Health is an equal opportunity employer.