Revenue Cycle Manager

Description

SUMMARY:

The Revenue Cycle Manager is responsible for supervising the day-to-day activities of the direct staff to ensure that all information for proper billing is complete and accurate; monitors daily work on each staff member. Ensures that all functions performed by staff conform to policies and procedures.

This position is responsible for the financial operations of the revenue cycle including patient billing, managing, directing, monitoring and reimbursement activities on all services including securing, maintaining, and distributing the most current coding and payer information and implementing changes that supports timely and accurate filing and reimbursement.

Essential Duties and Responsibilities:

• Plans, supervises, and coordinates all activities of billing department area pertaining to patient billing, communications with health insurances, collections, cash posting, account management, contract analysis and billing.
  • Provides technical advice and assistance as needed.
  • Provides on-going training and guidance on claims and billing errors to clinicians and staff and how to correct.
  • Works with all third-party payers to establish an information highway for billing and follow-up on claims.
  • Solves complex billing issues for staff and with insurance carriers.
  • Understands the considerations of coding in Value Based payment contracts.
• Responsible for oversight of entire financial cycle from patient registration to payment and collections
• Develop & implement and enforce policies and procedures to ensure compliance with federal and state regulations as well as accreditation standards and implementing changes from payer bulletins. 
  • Collaborates with management on company impact and changes needed in Billing.
  • Notifies and trains staff of significant coding, patient intake and billing changes.
  • Explains laws, policies, procedures, and regulations to employees and the public.
• Establishes controls and reviews mechanisms for every procedure to ensure that systems and procedures are being followed correctly.
• Ensure accurate and timely submission of claims.
  • Corrects critical errors to maintain denial of 3% or less.
  • Ensures that all electronic claim submission and electronic reimbursement issues are addressed by working with vendors and/or Information System.
  • Maintains all billing profiles that prevent claims from final billing (transmitted or sent incorrectly).
• Establishes controls and reviews mechanism for every procedure to ensure that systems and procedures are being followed correctly.
• Compiles data, information, and/or statistical reports as required or requested by the designated department.
• Coordinates the workflow and ensures deadlines are met.
• Ability to audit provider coding and make recommendations and educate provider on coding.
• Evaluates work performance of subordinate personnel and recommends personnel actions such as merit increases and promotions to the CFO in the area of assignment; resolves disciplinary matters and counsels with staff as necessary and evaluation reports
• Makes appropriate recommendations to CFO
• Performs other duties as assigned.

Knowledge:

• Knowledge of healthcare revenue cycle
• Knowledge and compliance with sliding scale
• Knowledge of provider credentialing
• Knowledge of CPT and ICD-9/10 coding
• Knowledge of insurance companies and their rules and allowables
• Knowledge of medical terminology
• Knowledge of HIPAA and other applicable state/federal requirements
• Knowledge of applicable state collection laws
• Knowledge of FQHC billing practices

Technology skills:

• Moderate to advanced computer skills including Word and Excel
• Internet navigation
• EPIC experience preferred.  EMR/EHR software experience, experience with multiple EMR/EHR platforms required.
• Ability to type 30 correct words per minute.
• Ability to operate a personal computer, related software, and others standard office equipment.

Education and Experience:

• Certified Professional Coder (medical, dental and behavioral health) highly preferred.
• Certified Professional Practice Manager highly preferred.
• Graduate from accredited billing school recommended.
• Bachelor's degree highly preferred.
• At a minimum of five years of management, supervisory, or lead-worker experience; or an equivalent combination of related education and experience.

Knowledge, Skills and Abilities:

• Billing Expertise
  • Thorough knowledge of the electronic billing system and all billing related profiles on multiple EMR systems.
  • Thorough knowledge of all third-party payer billing requirements.
  • Thorough knowledge of rules and regulations regarding government-sponsored billing.
• Administration
  • Considerable knowledge of bookkeeping principles and office practices and procedures.
  • Considerable knowledge of rules, regulations, procedures, and work performed in the assigned area.
• Operations
  • Ability to direct, plan, supervise, coordinate, and evaluate the work of subordinate personnel in an effective manner.
  • Ability to effectively plan and organize workflow, activities, and scheduling to ensure efficient departmental operations.
  • Ability to evaluate, improve, and make suggestions for improvement.
  • Ability to prepare and maintain routine departmental records and reports.
  • Ability to complete and evaluate forms relating to a patient's personal, financial, and medical history.
• Personnel Management
  • Ability to plan, direct and coordinate the work of subordinate personnel in an effective manner.
  • Ability to supervise and train subordinate personnel.
• Communications
  • Ability to express ideas clearly and concisely in oral and written form.
  • Ability to speak clearly and distinctly and provide assistance to employees and the public in a pleasant and courteous manner.
  • Ability to establish and maintain effective working relationships with departmental managers, administrative staff, other employees, patients, and the general public.

PHYSICAL DEMANDS: The physical demands described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodation will be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand, walk, talk, and hear, use hands to finger, handle or feel. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee is frequently required to lift and/or move up to 20 pounds. The special vision requirements for this job are close vision (clear vision at 20 inches or less), color vision (ability to identify and distinguish colors).

WORK ENVIRONMENT: This position is required to work on site.  The work environment characteristics described herein are representative of those an employee encounters while performing the essential functions for this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

MedNorth Health Center provides comprehensive health care services, inside a multi-cultural medical/dental clinic, to all individuals; insured, uninsured, and underinsured. The building is heated in winter and air conditioned in the summer with noise levels of moderate to loud. We serve patients who speak multiple languages and who may need the assistance of an interpreter. In this position one may be subject to exposure to copier toner, correction fluid, bright fluorescent lighting, and continuous personal computer exposure.

This job is a Blood borne Pathogen’s risk category III position.

GENERAL EXPECTATIONS:

• The employee is expected to attend work daily on-site and to be at work on time M-F 8am-5pm.
• The employee is expected to be a team player.
• The employee is expected to report absences in accordance with personnel policies and procedures.
• The employee’s work is expected to be accurate, neat, and thorough, and completed on time.
• The employee is expected to have a positive attitude, be cooperative, and considerate of others.
• The employee is expected to be dependable and is expected to accept responsibility for assignments and duties given.
• The employee is expected to dress and act in a professional manner and to adhere to all safety standards.
• The employee is expected to participate in staff meetings, be courteous and polite with patients and other staff.
• The employee is expected to maintain confidentiality.

Qualifications

Salary : $75,000 - $100,000