Manager of Revenue Cycle

The Manager of Revenue Cycle is responsible for overseeing and optimizing the entire revenue cycle process at IHC, ensuring efficient, accurate, and compliant billing and collections. This position plays a critical role in sustaining the financial health of the organization by managing all aspects of revenue generation, reimbursement, and payment posting. The Manager of Revenue Cycle will work closely with clinical, administrative, and financial teams to enhance revenue performance, ensure compliance with federal and state regulations, and implement industry best practices.

Under the general direction of the CFO, the Manager of Revenue Cycle is responsible for the management of third-party payor contracts (Managed Care Entities) and maintenance of all Accounts Receivable and Billing related record-keeping systems and involves a technical independence guided by administrative routines, requirements of others and established schedule. The position provides guidance of a functional nature to staff members directly involved with the IHC finance, both in the corporate office and at the sites. Position supervises the billing department staff. Working closely with IHC health center operations team and the IT department,, the Manager of Revenue Cycle participates as a member of a team who develops and implements, maintains, and evaluates corporate information systems.

Evaluation of performance
Performance will be evaluated based on meeting specific goals, productivity measures, employee satisfaction scores, and other quality indicators for this position such as: IHC strategic objectives; site strategic objectives; functional capabilities; leadership and/or employee capabilities; IHC commitments, quality measures, and productivity measures.

Application of knowledge
Requires expert knowledge of an extensive body of managed care contracting, medical billing and medical coding rules and regulations, specifically related to state Medicaid reimbursement – Healthy Indiana Program (HIP) and Medicaid Contract Offices (MCOs) and Medicare (CMS). Requires knowledge of, precedents, procedures, and past practices applicable to medical billing and medical coding and cost recovery along with knowledge of IHC’s structure, goals, and specialized terminology. Requires knowledge of CPT and ICD coding. Requires knowledge of managed care and third-party payer contract negotiations including value-based terms. Knowledge permits the employee to develop new approaches or improve current administrative operations within the confines of the laws and regulations.

Third-party payer contract negotiation/management:

• Implement and manage third-party contracts
• Monitor third-party contracts
• Analyze data to determine rates for contract negotiations
• Work with CFO to negotiate new and renewal contracts
• Evaluate payor rate proposals
• Review contracts ensuring terms are agreed by all parties
• Work with CFO to terminate contracts, as needed
• Maintain and update as needed detailed contract profiles, including key terms
• Meet as necessary with CFO and/or CEO regarding contract updates/status
• Guide internal resolution to payor issues, including under payment

Medical Coding and Cost Recovery:

• Completion of all 2nd and 3rd party requests for payments forms
• Preparation of all data input forms for the accounts receivable
• Manages accounts receivables and past due accounts
• Conducts monthly, quarterly, and annual AR “scrub”
• Manages provider credentialing, privileging, and MCO panel award, includes working with IHC’s Credentialing Specialist and enrollment vendor

Information Management and Data Analysis:

• Compiles information for periodic financial reports
• Assists the CFO on special projects as needed
• Analyzes and presents data in a format conducive to decision-making by IHC managers
• Identifies and develops measuring tools for corporate strategic objectives
• Assists with the identification of data trends.
• Assists management with the use of information sources

Supervision and Coordination with CFO

• Supervises billing department staff—reviews work and evaluates performance.
• Ensures knowledge advancement and professional development of billing personnel
• Assists CFO in establishment and oversight of internal controls for AR/billing
• Prepares required reports as directed by the CFO

Leadership –Able to: share compelling vision and direction; build strong, engaged, and empowered teams; drive and foster IHC mission, vision, and values; drive productivity and achieves result; follow standard problem-solving process; make data-driven, evidenced-based decisions; hold others accountable for performance

Strategic Planning – Able to:

• Demonstrate near and mid-range planning skills
• Anticipate and alert others to problems with projects or processes
• Evaluate and monitor corporate strategic objectives

Logic and analysis – Able to:

• Demonstrate analytical problem solving, decision-making, and trend analysis skills
• Draw evidenced-based conclusions; recommend and implement evidenced-based solutions
• Perform necessary mathematical calculations
• Organize a variety of statistical figures

Communication – Able to:

• Collaborate with clinical and administrative teams to enhance workflows that impact the revenue cycle, such as registration, scheduling, and documentation
• Demonstrate effective verbal and written communication with a multidisciplinary team
• Maintain effective working relationships with management team and other staff
• Read, understand, organize, and effectively explain complex, financial and statistical data

Medical Billing and Accounts Receivable – Able to:

• Demonstrate knowledge of accounting principles and methods
• Demonstrate knowledge of ICD and CPT coding
• Apply recent regulations/guidelines on non-profit, health care billing and revenue
• Understand, interpret, and prepare financial reports

Administration and Management – Able to:

• Prepare detailed, organized, and accurate work product; consistently meet deadlines
• Manage the medical billing/accounts receivable department
• Demonstrate effective supervisory skills: recruiting, mentoring, disciplining, and developing
• Develop high performing teams; maintain a team approach to problem solving & workflow
• Prioritize tasks and time; follow up with subordinates, superiors, and co-workers
• Make decisions and judgments that are demanding and interpretive; tolerates ambiguity
• Plan and organize work with minimal supervision

Process Improvement and Optimization – Able to:

• Develop and implement policies and procedures to streamline revenue cycle processes, reduce errors, and increase efficiency
• Analyze revenue cycle workflows to identify opportunities for improvement and recommend and implement changes that maximize revenue and improve the patient experience.

Qualifications:

• BA/BS degree from an accredited school with 3-5 years experience in third-party payor contract negotiations/management, medical billing and 3 years experience supervising non-exempt staff.
• Experience may be substituted for education. Experience with MCOs and/or FQHCs preferred