REVENUE CYCLE MANAGER

Description

This job description is a sincere effort to guide you as you focus on what matters. It takes an exceptional Team to Dazzle our patients, intentional processes to alleviate frustration among our Team, and thoughtful administrative planning to support those processes.  That’s how we’ve laid this out, and the order in which we’d like to see you spend your efforts improving MEC. 

With all the gusto we can muster, THANK YOU for Dazzling our Team. We hope that MEC can Dazzle you in the same way; we’re sure going to try.  Now, let’s get to it! 

Build and Maintain a Cohesive Team  

McFarland Eye Care is only as good as its collective Team and, as a manager, you are an essential part of building a Dazzling Team.  Here are the basic responsibilities: 

1. Hire Team members that demonstrate and adhere to MEC’s core values. You are central to the interview process for your Team and will be the primary filter to ensure those we allow into our practice demonstrate our core values. 

2. Knock Their Socks Off. This is our way of saying empathy matters. Our Team needs to be able to demonstrate empathy in the interview process through specific questions meant to help bring this out. It also needs to be stressed that our expectation is to knock not only our patients socks off, but our Team’s as well. 

3. Everything Speaks. Everything that our patients interact with while they are here with us at MEC tells them a story.  We want that story to be, “we are experts, here to listen and help you with your eye care needs.” The details of our patients’ experience matter, and we need detail-oriented people minding their experience. Whether it’s making sure we’re getting the right insurance information, documenting our charts correctly, or keeping our entry ways, bathrooms, etc. clean, these details are important and speak to the patient about how we value them and their experience. 

4. Plug In. We want our Team to take ownership of their role here at MEC; work like their name is on the building because, for all intents and purposes, it is.  We want our Team to be proud to refer their family and friends to us, and proud to be associated with us. That only comes from everyone caring enough to plug into our mission, patients, and culture. 

5. Play. Pouring energy into our patients takes a lot of energy from our Team. Play is our commitment to pour energy back into them. It also speaks to looking for these qualities in our Team. Are they going to lift their Team with energy or detract from it?            

• Facilitate effective and timely communication among our Team.  Our managers play a pivotal role in making sure our Team is connected to the information they need and that starts by establishing dependable lines of communication. 

• Weekly Team meetings, attended by all.  The purpose is to: 1) hone the Team’s focus on departmental rocks, ensuring that continual progress is made, 2) provide group accountability on outstanding to do items, and 3) review relevant process changes shared through the Clinic Update that might pertain to the Rev Team.  This meeting should be held at the same time each week and should last no more than 20-30 minutes. 

• Sit-down conversations. We know that our Team responds well to one-on-one time with their direct manager. And even though there’s likely a lot of collective time for feedback and touch points throughout the week, we believe a casual (but more formal than talking over lunch in the breakroom) meeting no less than once per month is appropriate.  Find a setting where there isn’t a desk between you and the Team member, and invite candid feedback, trying to listen more than speaking. Address what matters and tailor each conversation to the Team member in front of you.  Consider documenting via a coaching to keep record of the things you’re talking about so you both can reference back to them.  This will also help take the stigma out of coaching forms. 

• Team emails as needed. To vary our communication channels and occasionally provide necessary documentation, emails will of course be a part of that communication mix and should be to the point while also providing relevant context for the info we’re providing…don’t just drop them into a topic, tell them a story! 

• Connect Team with training.  You should be well versed in using the platforms used by our Team, including Paycom, Nextech, Clearwave, TriZetto, and the Microsoft Office Suite.  Be prepared to connect our Team with the training they need on these platforms and other relevant skills, be it direct one-on-one training or assigning time with another Team member that can provide training. 

• Create a sense of Play. Play is our way of pouring energy back into our Team and will likely look different from one department to the next. Maybe we encourage nerf guns, blind gummy bear taste tests, play bean-boozled, etc. Find what works for your Team and make it a part of your culture! That said, here are some standards we’d like to set as a baseline. 

• Monthly birthday celebrations. Celebrating everyone’s individual birthday is a big ask on top of all our other responsibilities. That said, we can collectively celebrate all birthdays for the month with a cake and a heavenly chorus of “Happy Birthday”. 

• Anniversary cards.  We should take the time to deliver a handwritten anniversary card to each Team member, and perhaps consider writing each out for the month at the end of the prior month. 

Observe our Team. It’s important to set aside a minimum of two hours each week to observe one member of our Team continuously.  Shadow them and ask questions. Try to dig out the small frustrations in their day so we can fix them. Show them you are interested in them and the things they are concerned about. 

Accountability, accountability, accountability. Have the conversation you’ve been avoiding and make sure you’re in a mindset of rooting for this Team member’s success when you do it. That energy and mindset will be apparent to the Team member. Listen more than you talk and ask for their feedback on the issue. There are always multiple sides to an issue, and we need to take theirs into account as part of the conversation. 

Do not tolerate bad apples, they will spoil the whole bunch. 

Reach for Operational Excellence 

Teams are greatly enhanced by very intentional processes that are designed with efficiency and the very best patient outcomes in mind.  As our Rev Cycle Manager, you are responsible for maintaining the overarching infrastructure of the entire cycle, and we break that down into the following areas: 

• Preregistration.  This process involves our PHD and Front Office Teams as they schedule appointments and capture the demographic and insurance information necessary to verify coverage, benefits, and patient responsibilities.  Though these Teams do not report to you, consistent feedback needs to be provided when these processes are not getting us the information we need, leading to denials and write offs.  For surgery patients, this is where pre-authorizations would come in and, since these are becoming more and more prevalent, it’s more important than ever that we have an incredibly tight process to ensure we have what we need ahead of surgery to prevent write offs.  You will be part of our redundant efforts to ensure we’re not dropping the ball. 

• Registration. This encompasses our patients’ arrival; collecting any missing information, signing necessary consents, and collecting any known patient responsibility amounts.  This should be monitored and addressed in the same manner as Preregistration. 

• Charge Capture. The Team members involved in this are largely our Doctors and Scribes.  Doctors will determine the appropriate coding and our Scribes will document accordingly.  Once the record is complete, the doctor will review and sign off.  Your responsibility in this area is to establish processes to ensure the completeness and accuracy of the charges submitted, which could be a combination of auditing and more advanced data analytics. 

• Claim Submission.  This involves our Rev Team’s review of the charges that were captured by our Doctors and Scribes, scrubbing for known payer-specific claim processing notes.  Your responsibility here is to make sure our Rev Team is trained in those payer specifications, necessary modifiers, and to establish feedback loops to the doctors and scribes when consistent errors occur.  Also ensure that we’re building and maintaining custom claim edits to help us quickly identify potential denials ahead of claim submissions. 

• Remittance Processing. Our Rev Team is directly responsible for the timely and accurate application of received payments, as well as dropping balances to secondary claims as needed.  You are responsible for designing, maintaining, and implementing this process. 

• Denial Management.  It’s estimated that almost 60% of denied claims are never even resubmitted to the payer for appeal or reprocessing; we don’t want to be in that camp!  Design a workflow that ensures denials are worked in a timely fashion, with the ultimate goal of reprocessing all denials within 5 working days.   

• Patient Collections.  MEC works with a third-party collections agency to collect balances we’ve not been successful with.  Ensure consistency in this process with respect to both patient communication prior to being sent to collections (we should feel incredibly confident that we’ve done our best to not catch a patient by surprise here), and transmittal of data to the collection agency.  Our goal should be to exhaust our internal collections efforts prior to sending a patient over.  Based on our experience, patients would prefer to work with us directly and many times we’ve noticed that their lack of doing so is a lack of connecting with the patient before submission.  This process is an area where we can truly enhance the dazzle factor to our patients! 

The Administrative Stuff… 

Finally, our processes need to be supported by a honed administrative function, allowing them to work as intended…. 

• Credentialing. Oversee the process of maintaining credentialing for our existing providers and seeking payer credentialing for new providers.  In recent years, payers have become increasingly unorganized, which require us to be even more organized to combat.  This will include maintaining a database meant to help us track renewal dates, documenting conversations with payers to combat conflicting information, and providing regular feedback to payers when they are not living up to their end of the bargain. 

• Fee Schedule Maintenance. Verify that our Team is routinely uploading updated fee schedules for major payers to both TriZetto and Nextech.  This will facilitate a charge reconciliation process when payer payments are received. 

• Payer Contract Management. Negotiating payer contracts is a big undertaking that will involve several Team members and perhaps outside consultants.  That said, we must be organized around our contracts in terms of payer indexing (understanding how they pay relative to CMS and each other) and keeping track of our contract dates, and this is what we’d ask of you in this role. 

• Technology Application.  There’s probably not another area of the practice that’s as ripe for the robust application of technology than Rev Cycle.  That will take exploring, vetting, and networking for best-in-class solutions. 

Vital Reports to Monitor 

1. Collections. This is a high-level indicator of health. 
2. A/R Aging. Same. 
3. Write Off Report. Ensures integrity of A/R Aging. 
4. Denial Report. Enables operational feedback to Team. 
5. Denial Reprocessing Lag Report. Maintains timely reprocessing of denials. 
6. Surgery Charge Three-Way Match. Verifies surgery charge completeness. 
7. Encounter Match. Verifies clinic charge completeness. 
8. Payer Contractual Reconciliation. Confirms payers comply with their contract. 

Time Allocation 

• Team meetings and prep 4-6 hrs/week 
• One-on-one observation 2-4 hrs/week 
• Reporting review 4-6 hrs/week 
• Outside department feedback 2 hrs/week 
• Discretionary Remaining time 

Qualifications

Required Education

• High School diploma or equivalent.
• Bachelors degree preferred.
• Ophthalmic Coding Specialist Certification (current or obtained within one year).

Experience/Skills:

• Minimum of three years of current medical billing experience or equivalent combination of education, training, and healthcare experience
• Minimum of two years experience with electronic health records.
• Supervisory experience of three or more people.
• Typing ability of 50 wpm.
• Ability to work in a professional, positive, and pleasant way with patients and team
• Excellent interpersonal skills and able to work with a variety of personality types
• Strong verbal communication skills in order to converse clearly and professionally with patients and team
• Maintain a professional manner in stressful situations
• Functional knowledge of Microsoft Office Suite products i.e., Excel, Word, Outlook.