Revenue Cycle Manager

Position Details

Work Shift :

Day Shift (United States of America)

Scheduled Weekly Hours :

Department :

Physician Billing Dept

Overview of Position :

Manages and directly participates in the performance of the revenue cycle operations of Genesis Hospital and Genesis Medical Group (GMG) to maintain a high functioning revenue cycle. Plans, organizes, and directs overall operations of patient accounting functions for both hospital and professional billing. Manages and directly supervises daily operations of the billing, follow up and denial processes. Determines work schedules, monitors performance, resolves technical and project issues and educates staff.

ESSENTIAL DUTIES

1. Oversees all practice revenue cycle activities through direct and matrix reporting relationships with office managers, office and billing staff, patient registration, and other support staff within revenue cycle process. Coordinates revenue cycle interaction with the operations and revenue producing areas and providers.

2. Responsible for the oversight, development, and implementation of strategy and tactical aspects of patient accounts, appeals management, financial assistance and payment posting processes.

3. Analyzes CMS memorandums and payor reimbursement methodologies (Commercial and Government). Performs research reviews of process changes associated with new regulations and implements a compliant process for the system.

4. Analyzes daily financial data to determine areas of leakage and partners with departments to optimize collections and improve the capture of compliant charges. Performs root cause analyses with trends to share with appropriate service line leaders.

5. Monitors and maintains receivables, days outstanding in account receivables to maintain cash flow and optimize collections.

6. Maintains billing system and edits to assure compliance to billing and regulatory requirements. Works with third party payors, handles patient complaints, conducts employee training and performance evaluations.

7. Liaison to all hospital departments as it relates to billing, coding, denials, and CMS coverage guidelines.

8. Develops, produces, and reviews the Performance Indicator Report, or other similar performance reports within EPIC, with Hospital and GMG administration and physicians to demonstrate revenue cycle performance and comparisons to targets and benchmarks.

9. Works collaboratively with office managers to ensure that physicians and office staff capture and report accurate billing information and follow revenue cycle related point-of-service policies, such as collection of co-pays, treatment of self-pay balances, and appropriate charity care designation.

10. Oversees training / education in relation to all aspects of the revenue cycle process, from registration and point of service through the collections and reimbursement process.

11. Analyzes trending and secures process improvements consistent operational improvements in account resolution.

12. Oversees the denial management process, including working with billing and denial staff to track and trend recoveries, and to ensure appropriate communication and follow-up activities.

13. Works with Coding Manager, Contract & Compliance Manager, and other Physician Services administration to monitor and coordinate responses to the latest regulatory billing / payment requirements of the federal, state and 3rd party payers to ensure GMG offices are in compliance and that electronic data processing (EDP) systems and coding structures are maintained to minimize manual processing and maximize claims acceptance and reimbursement. Translates regulatory requirements into daily operational procedures. Expedites payment processing and resolves problems with major 3rd party payers.

14. Maintains compliance with applicable federal, state, and local laws and regulations, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

15. Researches and understands Regulatory requirements and maintains a consistent knowledge of payer changes, Governmental changes and / or billing requirements to ensure Genesis captures and is reimbursed correctly for all services provided.

16. Ensures all Medicare, Medicaid and Commercial guidelines are accurately administered for Genesis.

17. Prepares required reports using statistically sound information, displaying content in easily understandable format.

18. Secures data for month end scorecard metrics and builds action plans to meet and exceed targets.

19. Conducts team meetings for enhanced communication within Professional and Hospital patient accounts.

QUALIFICATIONS

1. Bachelor’s degree in education, business or other related field.

2. Must have a minimum of five (5) years’ experience performing similar work.

3. Demonstrates a broad base knowledge in the areas of patient registration, billing, accounts receivable and cash management, managed care contractual terms, financial reporting, and industry standards for healthcare revenue cycle management practices.

4. Ability to lead and manage diverse staff in a learning environment with frequent changes in departmental priorities. Ability to recognize necessary changes in priority of tasks and allocation of resources, and act upon them as required to meet workload balance.

5. Superior management skills that emphasize team building with the ability to provide clear direction to the department, while also functioning as an individual contributor. High level of initiative, drive and poise coupled with qualities of maturity, professionalism, flexibility, and patience.

6. Ability to interpret 3rd party payer contract requirements and recommend, design and implement procedures for compliance with regulations and standards. Ability to negotiate with insurance vendors, medical directors, and 3rd party payers when appropriate in order to facilitate the denial management process.

7. Ability to communicate and work with physicians, physician office personnel, associates, case managers, 3rd party payer review personnel, and others in order to expedite the revenue cycle processes to avoid negative financial impact on GMG.

8. Excellent communication skills (verbal and written), conflict management and strong facilitation and consensus building skills in dealing with various internal / external customers.

9. Demonstrates the ability to be a collaborator, a team player and a capable influencer and motivator; to think creatively and conceptualize innovative solutions to business problems. Must be able to act as a change agent / leader, coach, and mentor in order to secure buy-in and break down barriers.

10. Must be able to set and organize own work priorities, and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks / projects in an environment that may be stressful with individuals having diverse personalities and work styles.

11. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others.

PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS

1. Living the Genesis Mission, Vision and Values :

• Performs work in a manner that is quality focused.
• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.
• Results oriented and focused on achievement of objectives.
• Acknowledges and responds to the diversity of people and the situation.
• Encourages peers (others) to be owners of change.
• Always makes the effort to anticipate and exceed customer needs and expectations.
• Possesses the ability to engage others with patience and understanding.
• Acts in a manner that creates positive first and lasting impressions.
• Demonstrates the ability to own issues until they are resolved.

2. Patient Centered Care (patients / families, physicians, co-workers, all other internal / external customers)

3. Promotes Patient and Employee Safety

WORKING CONDITIONS / PHYSICAL REQUIREMENTS

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.

1. Works in an office environment.

2. Travels to other floors and to centralized files. May be required to drive to other locations. Answers telephone calls, uses personal computer and other business machines extensively. Bends, reaches, pushes and pulls file drawers to file records and reports.

3. Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds.

4. Vision abilities required include up close vision, peripheral vision, depth perception and the ability to adjust focus.

5. May be required to periodically rotate shifts and regular days off. All system employees must be willing to work all shifts, extra hours, holidays and emergency shifts as required.

This description reflects in general terms the type and level of work performed. It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.

Benefits include :