What are the responsibilities and job description for the REVENUE CYCLE MANAGER position at FIRST CHOICE PRIMARY CARE?
JOB CLASSIFICATION: Exempt
JOB SUMMARY
Supervises and coordinates the business functions of the Billing Department to ensure maximized cash flow for First Choice Primary Care. Revenue Cycle Manager monitors day-to-day operations of the Billing Department to include accounts receivable, insurance filing, billing, collections and reporting. The Revenue Cycle Manager works closely with CFO to achieve financial goals of the organization. Assists staff and patients with billing and financial matters and stays abreast of the current coding, payer and regulatory changes inherent to the medical field.
RESPONSIBILITY AND AUTHORITY
SUPERVISORY DUTIES
- Manages eClinical billing functions including all phases of coding, data entry, charge entry and other claim activity to ensure that services are billed on a timely basis.
- Maintains a knowledge base of Medicare and Medicaid regulations and other insurance company requirements.
- Analyzes trends affecting A/R and report’s recommendations to CFO.
- Uses eClinical reporting system to ensure that billable and collected revenue are maximized.
- Uses eClinical reporting system to ensure that adjustments/write-offs are taken per FCPC financial policies and procedures.
- Working closely with the Staff Accountant, responsible for ensuring that monthly EFTs recorded in ECW match deposits in the bank.
- Oversight of all provider credentialing and enrollment applications; maintaining constant oversight and communication with the Accounting Coordinator and external agency to facilitate timely approval.
- Directs and supervises all billing department employees. Completes performance evaluations and provides direction and guidance daily.
- Stays abreast of coding and payer changes by attending workshops, webinars, and audio conferences and frequent review of CMS and GAMMIS websites.
- Maintains and updates provider lists with insurance companies, managed care contracts and employers to include Workers Compensation for staff reference and information.
- Communicates and generates work tickets with eClinical and/or NEOS any system problems that are creating claim issues.
- Reviews eClinical monthly reports to trend claim denials and provide feedback to Medical Director and COO opportunities to correct errors on an individual basis.
- Promotes staff development by providing billing and coding in-services.
- Assists patients and FCPC staff with billing and insurance questions making sure that patient phone inquiries regarding account balances are returned timely to promote positive customer service.
- Serves as point of contact for collections activities by meeting with patient to sign Patient Payment Plan and generates collection letters per collection policy.
- Communicates with the treatment team any anticipated issues with coverage that may impact the sequencing and timeliness of care.
- Maintains contact and communication with CGHN, PHL, Medicare, Medicaid, Managed Care Organizations and commercial insurance companies to promote a positive response when questions and problem-solving opportunities arise; always establishing contact with newly appointed representatives.
- Ensures that Billing Department follows all necessary HIPAA regulations to protect patient information.
- Brings any compliance/regulatory concerns and major adverse trending A/R issues to the immediate attention of the CEO and Compliance Officer.
- Maintains fee schedules in ECW assuring that charges for all CPT codes are appropriate for maximizing revenue and suggests changes to fees to CFO.
- Reconciles annually payments from insurance companies agree with contracts as provided by CGHN or contract provider and assures that all contracts are current.
- Stays abreast of any additional revenue opportunities, providing research follow-up including proper coding/billing and clinical requirements to CFO.
Supervisor Daily and Weekly Responsibilities
- Ensures that cash reports are completed daily.
- Ensures that returned mail reports are maintained daily.
- Ensures that claim follow-up reports are worked on a weekly basis.
- Monitors credit balances on patient accounts and processes credit refunds per policy and procedure.
- Ensures that patient statements are generated monthly.
- Ensures that electronic claims are generated daily.
- Ensures that Encounters without Claims report is worked on a weekly basis to ensure that all billable claims are generated and communicates with providers of approaching timely issues.
- Ensures that all payments, electronic and paper, are posted daily.
- Promotes the exchange of information between the Billing Department and the Business Office to support interdepartmental team building and timely correction of errors or deficiencies.
- Performs other duties as assigned and required to maintain an efficient and effective workflow within the Billing Department.
QUALIFICATIONS, KNOWLEDGE, SKILLS
Strong work ethic required.
Associate’s degree required. Bachelor’s degree preferred.
Minimum of three (3) years’ experience in insurance billing department essential.
Prior management position or supervisory experience preferred.
Coding certification highly desirable.
Working knowledge of healthcare insurance, particularly Medicare, Medicaid and Managed Care.
Strong knowledge of ICD-10 and CPT coding.
Basic computer skills and knowledge of the required documentation in progress notes of Electronic Health Record.
Has performed claims transmission, payment posting, and insurance adjustments.
Ability to review claims and determine if payment is correct or denial is appropriate.
Ability to audit accounts for accuracy of coding, billing, discounts and adjustments.
Understands entire revenue cycle of a medical practice.
Ability to analyze and work trending financial data.
Proven leadership skills, ability to prioritize daily task functions, recommend process changes as needed, and meet departmental targeted goals for A/R.
Ability to train and in-service departmental staff with a strong initiative to stay abreast of billing, coding and compliance changes.
TYPICAL PHYSICAL DEMANDS AND WORKING CONDITIONS
Work is performed in a typical medical office environment. Sitting for long periods of time before a computer screen and requires manual dexterity to operate a keyboard, calculator and other office equipment. Requires corrected vision and hearing to normal range. Requires some overtime to complete the daily tasks of a medical environment. Involves frequent interaction with staff, patients, and the public. Some stress due to supervision of staff and deadlines based on Close of Month activities required for accurate accounting practices.
INFECTIOUS DISEASE EXPOSURE LEVEL: 2
JOB RELATIONSHIPS
Supervised By: CFO
Employees Supervised: Billing Clerk
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