Manager, Revenue Cycle

ESSENTIAL FUNCTIONS

• Manages the day-to-day operations of the billing department to maximize net revenues and cash flow by managing all aspects of the revenue cycle while ensuring adherence to policies and procedures.
• Monitor accounts receivable activity and initiates appropriate corrective measures as needed.
• Communicates performance data and associated action plans to Senior Leadership.
• Identifies and implements processes to achieve key revenue cycle metrics including but not limited to a/r days, unbilled a/r, denial percentage, and cash collections.
• Analyze large volumes of data and provide financial analysis and regularly presents trends, movements, and status to Senior Leadership.
• Review billing work queues regularly to ensure that workloads are distributed evenly and that the department metrics are being met.
• Resolve complex patient, physician, and other issues when necessary.
• Manages self-pay receivables including vendor relationships to help resolve AR. Inclusive of self-pay receivables is the process of charity review and bad debt management.
• Develop and implement policies and procedures for designated areas; evaluate new systems and methods and recommend changes as necessary.
• Communicate with payers and know when and how to escalate payer issues.
• Oversee the hiring, training, and supervision of department personnel.
• Maintains comprehensive knowledge of 3rd party billing requirements and reimbursement principles. Also maintains comprehensive working knowledge of payor contracts and ensures that payors are billed according to contract provisions.
• Conducts regular meetings with staff to discuss third-party reimbursement methodologies. Provides direction to staff on changes in managed care reimbursement and expectation of changes in insurance guidelines.
• Keeps abreast of compliance regulations, standards, and directives regarding governmental/regulatory agencies and/or third-party payers. Ensure communication and education of such to the Billing department as well as other Revenue Cycle Leaders.
• Must be able to meet deadlines given by Manager or Senior Leadership.
• Research and resolve discrepancies in a timely manner.
• Works with sensitive and confidential materials and must be able to exercise discretion.
• Verifies and updates patient registration information in the practice management system.

EDUCATION

• High School diploma or equivalent working knowledge preferred.
• BA/BS in Business Administration, Accounting, Finance, or equivalent is preferred.

EXPERIENCE

• A minimum of five years of experience in a leadership role within a billing department in healthcare revenue cycle operations.
• Prefer experience working with multiple physician specialties.
• Previous supervisory experience and strong leadership skills with an ability to motivate with a positive attitude that positively impacts others.

REQUIREMENTS

• Demonstrated successful healthcare revenue cycle leadership experience.
• Experience analyzing and trending financial data.
• Excellent written and verbal communication and presentation skills.
• Excellent critical thinking, troubleshooting, and analytical skills.
• Excellent interpersonal skills including conflict management.
• Experience working in Excel (advanced formulas, pivot table)
• Well organized and able to meet deadlines.
• Excellent attention to detail.

KNOWLEDGE

• Knowledge of claims processing and editing systems.
• Strong knowledge of Medicare and Medicaid payer guidelines across multiple states.
• Knowledge of CPT, HCPCS, and diagnosis coding.

SKILLS

• Skill in effective data collection and analysis.
• Interpersonal skills are essential to communicate effectively, written and oral, with internal and external personnel at various levels.
• Skill in effectively managing multiple projects simultaneously.

ABILITIES

• Ability to multi-task and work well under pressure.
• Ability to analyze problems and interpret information and prioritize and reprioritize, as necessary.
• Ability to work independently, and as part of a team.
• Ability to read and interpret payer contracts.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment.
• Extended work hours at or near month end to meet department objectives may be necessary.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching are required.