Revenue Cycle Manager

Description

COMPANY OVERVIEW:

At Holon Health, we are dedicated to revolutionizing the way healthcare services are delivered. With a strong focus on community health, we strive to provide support and solutions that address the whole health needs of people with Substance Use Disorder (SUD). We help these individuals navigate chronic medical conditions, SUD, and Behavioral Health needs with a focus on prevention, integrative treatment, and recovery.

Holon Health’s initiatives develop, support, and maintain relationships with provider partners and community-based organizations to promote programs advocating long-term health and wellness for this complicated population. By acting as the first point of contact for the justice systems and programs with whom we partner, Holon Health provides timely and efficient brief interventions to better prepare patients to receive community-based services and engage in proactive, prosocial behaviors.

Position Summary

We are seeking a highly motivated and experienced Revenue Cycle Manager to support key aspects of our revenue cycle management (RCM) system. This role will be responsible for optimizing our RCM configuration, ensuring efficient denial management, maintaining provider credentialing, and negotiating and managing health plan contracts. As our second RCM, the ideal candidate will be a detail-oriented individual with a strong understanding of healthcare reimbursement and a proven ability to lead and collaborate effectively.

What Makes An Ideal Candidate

The ideal candidate at Holon Health is a dynamic individual who possesses meticulous attention to detail and excels as a team player. They possess effective communication skills, along with grit, tenacity, and resilience to navigate challenges. Demonstrating compassion and empathy, they approach interactions with sincerity and understanding. Additionally, their ability to inject a touch of playfulness adds a unique and positive element to the workplace. They exhibit relentless curiosity to understand the why, never relying on the shortcut of assumptions. Guided by a strong moral compass, they consistently strive to bring the wow factor to every aspect of their work.

RCM Configuration

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Analyze and optimize the RCM system configuration to ensure accurate and efficient coding, billing, and claims submission.
• Stay current with regulatory changes and industry best practices, and implement necessary RCM system updates.
• Collaborate with IT and other departments to ensure system functionality and data integrity.
  
  

Denial Management

• Analyze denied claims to identify root causes and develop strategies for improvement.
• Manage the denial appeals process, ensuring timely and accurate responses to payers.
• Track and report on denial trends and implement corrective actions to minimize denials.
  
  

Provider Credentialing

• Manage the credentialing process to ensure timely enrollment and participation with payers.
• Manage the vendor relationship with Provider Passport.
• Maintain accurate and up-to-date provider credentialing information in all relevant databases.
• Monitor credentialing expiration dates and proactively initiate renewal processes.
  
  

Health Plan Contracting

• Negotiate and manage health plan contracts to ensure optimal reimbursement rates and terms.
• Analyze health plan contracts for accuracy and completeness.
• Stay informed of changes in health plan policies and procedures, and communicate them to staff.
  
  

Requirements

QUALIFICATIONS:

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field (MBA preferred).
• Minimum 5 years of experience in revenue cycle management within a healthcare setting.
• Proven experience with RCM system configuration and optimization.
• In-depth knowledge of healthcare reimbursement methodologies (e.g., CPT, HCPCS, DRGs).
• Strong understanding of denial management processes and best practices.
• Experience with provider credentialing and health plan contracting.
• Excellent analytical and problem-solving skills.
• Strong communication, interpersonal, and leadership skills.
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint).
  
  

Benefits

• $80,000-$100,000 per year DOE
• Health Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Short-Term and Long-Term Disability
• Teladoc
• Legal Assistance
• Unlimited PTO
• 401k with company match and immediate vesting
• Ample room to grow
• The unique opportunity to be a part of a growing company in its early stages