What are the responsibilities and job description for the Revenue Cycle Manager position at Minnie Hamilton Health System?

MHHS

POSITION DESCRIPTION

TITLE: REVENUE CYCLE MANAGER (RCM)

DEPARTMENT: FISCAL SERVICE

REPORTS TO : CHIEF FINANCIAL OFFICER

REVIEWED/APPROVED DATE:

UPDATED:_____________________________________________

BASIC PURPOSE:

The Healthcare Financial Management Association (HFMA) defines revenue cycle as "All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue." ln other words, it is a term that includes the entire life of a patient account from creation to payment. Revenue cycle processes flow into and affect one another. When processes are executed correctly, the cycle performs predictably. However, problems early in the cycle can have significant ripple effects. The further an error travels through the revenue cycle, the more costly revenue recovery becomes.

Responsible for the improvement of utilization and other operational activities that support the overall objectives of MHHS. Will strive to continuously streamline operations, improve daily system usage and functionality.

The RCM will be responsible for overseeing the billing teams and all billing operation processes (i.e, insurance eligibility processes, charge processing, claim submission/processing, payment processing, collections and A/R, denial management, reporting results and analysis, concurrent and retrospective auditing, proper coding, and insurance contract reviews). Oversee the day to day activities of the central business office.

Health care revenue cycle management involves many strategies, including procedures that hospitals and clinics use to improve cash collections and meet liquidity goals. These strategies also include customer receivables valuation, underpayment recovery policies and transactions involving federal government programs such as Medicare and Medicaid.

Oversee departments associated with revenue cycles, including billing, collections, health information management, etc. Work closely with CFO in monitoring, educating, management of staff. Review payors contracts, payments and reimbursement. Ongoing monitoring, Management of claims processing, payments and revenues. Utilizing technology as an essential tool for monitoring and educating staff, providers, patients and public. Compliance with CMS, Medicare, Medicaid, payors, etc. Sliding Fee and charity care programs.

QUALIFICATIONS:

Experience in A/R management, EOB interpretation, working with payers to correct issues with claims

adjudication, line item payment posting, electronic claim submission, clearinghouse set-up, and

intermediate knowledge of Excel with ability to utilize for data analysis. Understanding of basic Business Office functions to include patient registration and checkout, billing process via electronic and paper claim method, EOB interpretation and payment posting, denial tracking and denial resolution process,

all aspects of accounts receivable management.

Experience in hospital, Rural Health clinic, Federally qualified Health center, Dental, Long Term care,

Ambulance, etc. and/or business office leadership preferred.

Experience in successfully managing of a team. Project Management experience required
Willingness to learn and educate yourself.
Bachelor's Degree in business or related field is preferred. Health care administration/revenue cycle

management experience preferred.

The individual in this position must take ownership in their leadership position, be dependable and

desire the opportunity to lead a team environment.

Must have excellent attention to detail and the ability to prioritize work flow and projects to meet

deadlines and demonstrate the ability to think critically under pressure.

Requires computer and systems competency in the following areas: working knowledge of systems and

interfaces preferably with CPSI, NextGen, Therapy Source, and LTC software, Microsoft Word, Microsoft

Excel and Microsoft Outlook.

Excellent writing and verbal communication skills and professional positive attitude are required.
Must have knowledge of revenue cycle management process local/state/federal regulations, Fair Debt

and Collection Practice Act, medical terminology, claims adjudication process and payer contract

familiarity.

GAAP, Working closely with CFO
Solid understanding of information systems
Must be detail oriented, organized, and have strong multi-tasking abilities
Competency in HIPAA Security regulations
Ability to demonstrate supportive relationships with peers, vendors, partners, and corporate/facility

executives

Strong knowledge of medical insurance billing and collections, coding and medical terminology, as well

as an overall understanding of Medicare and other third party payers

comprehensive knowledge of claims management, HIPAA standards, CMS requirements, managed

care, CPT, ICD-9, 10 and HCPCS Coding

Knowledge in healthcare compliance, including privacy and security regulations, confidentiality laws,

access and release information

Excellent and innovative problem solving skills and analytical abilities
strong sense of urgency and ability to meet required deadlines
Requires an understanding of multiple systems and processes that impact revenue cycle performance

and capabilities.

Possesses analytical ability sufficient to work in a data-heavy environment and to identify trends in the

data.

Effective communication (i.e., listening, written and verbal), negotiation, influencing decision makers,

business planning, strategy, problem solving, decision making and time management skills.

Understanding of the market, trends, competition, and key pain points for hospital executives.
Must be able to work in sitting position, use computer and answer telephone
Ability to travel between sites includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

ESSENTIAL FUNCTIONS FOR HEALTH INFORMATION MANAGEMENT SUPERVISOR

This description does not state or imply that the duties, essential functions, and job requirements are the ONLY parameters for this position. Associates are required to follow job related instruction and perform other job related activities requested by their supervisor.

All requirements are subject to possible modification in order to provide a reasonable accommodation to individual with physical or mental disabilities as defined by the Americans with Disabilities Act. Some requirements may exclude individuals who pose a direct threat or significant to the health and safety of themselves, the patients or other associates.

PHYSICAL REQUIREMENTS:

Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and bending are necessary body movements utilized in performing duties.
Must be able to sit for extended periods of time.
Must be able to read and write legibly in English.
Visual acuity must be within normal range.
Must have reading and comprehension ability.
Must have ability to move freely through the facility to perform daily and special tasks.
Hearing within normal range is required.
Must have manual dexterity to operate keyboards, fax machines, telephones, and other business equipment.

MENTAL REQUIREMENTS:

• Must be capable of handling information of confidential nature.

•Must have the ability to work successfully under highly stressful conditions, and must be capable of adapting to varying workloads and work assignments on a constant basis.

•Must have the ability to comprehend and perform oral and written instructions and procedures.

•Must have effective reading and comprehension skills.

•Must have strong communications skills, written and verbal.

•Must be able to work weekends, holidays, and all shifts if required.

•Must have ability to prioritize tasks.

•Must have independent decision-making ability.

•Must have the ability to respond to emergency situations in a calm, professional manner.

•Must be capable of using computers to input and retrieve information.

•Must have the ability to perform concentrated and complex mental activity with frequent involvement in complex and highly

technical situations.

•Must have the ability to make sound, independent judgments based on scientific principles, or sound business judgment and also be able to collaborate with other multi disciplinary team members in an appropriate fashion.

ENVIRONMENTAL CONDITIONS:

(POTENTIAL FOR)

Exposed to high levels of stress and anxiety.
Must be able to perform duties despite constant interruptions.
Exposure to toner and lighting from copy machines and printers.

EQUIPMENT USED: This must be considered only a representative, partial list, since equipment changes may occur at any time.

Beeper

Telephone/Paging System

Computer Terminal and Printers

Photocopying Equipment

Calculator

Shredding Machine

Scanning/Microfilm/Microfiche Machine

Typewriter

Facsimile equipment

STANDARD/CRITERIA
a	Works with other hospital departments to identify issues, communicate new policies and problem solving.
b	Designs and updates departmental procedures, policies and job descriptions to attain and maintain department efficiency, customer satisfaction and standards for accrediting and licensing agencies.
c	Maintains patient, diagnosis and physician indices.
d	Participates in interdepartmental and intra departmental task forces and continuous quality improvement activities, serving as leader, facilitator, or team member; encourage participation of associates.
d	Develops work schedules for associates to ensure proper coverage of the department, approving nonscheduled time according to departmental need and hospital policy.
e	Demonstrates thorough knowledge of the job descriptions and key requirements for each position in all areas; knows how to instruct others in the performance of duties; holds associates accountable at all times for the responsibilities inherent in their position.
f	Maintains a document storage/record retention program in accordance with hospital and regulatory requirements. Consistently is attentive to record keeping, documentation and other record maintenance requirements inherent to medical record functions.
g	Reports to CFO, finance projects for positive changes within the scope of the department
h	Evaluates and coordinates innovative ideas to facilitate growth and changes of the medical records, billing and patient accounts departments.
i	Consistently makes sound recommendations after gathering factual objective information on matters of hiring, commendation, promotion, transfer, discipline and termination in accordance with the hospital personnel policy.
j	Meets regularly with department associates to inform them of any changes, developments or issues within the department or institution.
k	Participates in continuing education to maintain registration.
l	Participates in developing, organizing and conducting in service education programs, maintains documentation of such. Develops and maintains an ongoing staff development orientation program for associates.
m	Supervises directed practice activities for medical record students.
n	Participates in continuing education to maintain registration.
o	Participates, or is represented in community, state and national health care organizations for the purpose of networking and establishing appropriate services.
p	Demonstrates good judgment by conducting all aspects of supervision in a fair, firm, consistent and objective manner. Assesses situations from a variety of perspectives, consider several alternatives, and choose appropriate actions.
q	Consistently monitors and documents associate performance; always takes immediate action upon the discrepancy situation; documents action and rationale for decision.
r	Maintains an excellent rapport and professional relationship with associates, gains cooperation of staff while working toward institutional and departmental goals; responds to associate concerns in a professional manner; maintains appropriate departmental communication.
s	Coordinates and facilitates Medical Record Review functions to ensure compliance. Reports results and recommendations to IQM. Follows through with implementation.

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