RCM MANAGER REVENUE OPTIMIZATION

PURPOSE AND SCOPE:

The purpose of this position is to support Pinnacle Healthcare Revenue Solutions’ mission, vision, core values and customer service philosophy.

The RCM Revenue Optimization manager oversees the work of their team and ensures adherence to quality standards, deadlines and proper procedures.

CUSTOMER SERVICE:

• Accountable for outstanding customer service to all external and internal customers.
• Develops and maintains effective relationships through effective and timely communication.
• Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.

PRINCIPAL RESPONSIBILITIES AND DUTIES:

• Responsible for supervising assigned staff, including attendance, paid time off, payroll, training, corrective action and performance evaluations.
• Ensures staff production, quality and compliance is maintained to company standards.
• Ongoing motivation and training to staff.
• Identify and resolve problems and inconsistencies and implement appropriate corrective procedures to resolve.
• Functions as a liaison between upper management and position leads regarding revenue cycle issues.
• Functions as a liaison between the client and associated client professional organizations, such as vendors, credentialing contacts, and other agencies as needed.
• Is current on all payer bulletins and communicates pertinent information to staff, peers and management
• Prepares training material for all job functions, including PM system, payer portals, and any other internal and external resources required for the team to function at the highest level of proficiency.
• Trains or instructs current and new employees in job duties or company policies or arrange for training to be provided
• Participates in the work of subordinates to facilitate productivity or to overcome difficult aspects of work.
• Interprets and communicates work procedures and company and client policies to staff.
• Resolves customer complaints or answers customers’ questions regarding policies and procedures that escalate from any department associate.
• Makes recommendations to upper management concerning such issues as staffing decisions or procedural changes.
• Recruits, interviews and selects new employees with assistance from human resources.
• Develops work schedules according to budgets and workloads.
• Designs, implements or evaluates staff training and development programs, customer service initiatives or performance measurement criteria.
• Monitors staff for compliance of the organization’s confidentiality policy in accordance to the Health Insurance Portability and Accountability Act (HIPAA) regulations.
• Completes all tasks assigned by the Director in a timely manner
• Communicates any issues to the Director for tasks or other performance related that will extend a deadline or adversely affect revenue
• Improve organizational performance by identifying opportunities for improvement in the revenue cycle process
• Participates/Directs assigned general administrative projects.

ESSENTIAL ROLE FUNCTIONS:

• Consistently monitors assigned client A/R aging, denials and payer influences.
• Aggressively monitors work queue, and or other reports, for adverse activities or trends, and prioritizes work activity to correct
  1. Examples: (not exhaustive)
     • Accounts that haven’t been worked in 30 days and/or
     • Accounts that are approaching timely filing
     • Appropriate action on accounts according to the AR Escalation policy
     • Productivity lag
     • Assure accounts are worked as assigned (payer, age, escalation…)

• Perform Root Cause Analysis for denial trends and assist with process redesign to prevent/reduce avoidable denials
  1. This may involve workflow recommendations to the client
• Communicate non-covered services to the Director for research and policy development
• Monitor non-contractual adjustments for reason and to identify trends and appropriate action
• Assure customer service representatives (CSR) have access and training to perform task such as:
  1. Able to understand and articulate a payer’s explanation of benefits
  2. Explain copayment and deductibles
  3. Can accurately update patient demographics and insurance
  4. Are able to refile a claim (based on the complexity of the account and payer)
• Assure CSR have an assigned Accounts Receivable Specialists to promptly assist with complicated account resolution
• Provide adequate CSR coverage consistent with the client’s time zone

EDUCATION:

• High School diploma or equivalent is required.
• Associates Degree in Medical Billing and Coding or a related field is preferred.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Employee must be able to sit at a desk for at least eight hours per day while frequently using their fingers to type. This position requires that the employee be able to speak clearly, look at and read a computer screen. Occasionally, this position may require that the employee reach or stretch for objects.

EXPERIENCE AND REQUIRED SKILLS:

• 5-7 years of experience in medical billing office or related environment.
• Must have a thorough understanding of the entire revenue cycle including: customer service, charge entry, cash applications, accounts receivable, credentialing and coding.
• Candidate must understand government and managed care payment methodologies and demonstrate knowledge of terms such as contractual adjustment, allowed amount, coinsurance, denial and denial processes.

• Proven knowledge and ability to apply ICD10 and CPT Coding is a must.
• Knowledge and ability to stay abreast of HIPAA laws and regulations and maintain compliance

• Attention to detail to ensure accuracy of information
• Excellent MS Suite skills including Excel, Word, and Outlook
• Proven analytical skills
• Ability to present, communicate initiatives, results and analyses to multiple levels of management and clients
• Current working knowledge in medical professional claims processing, payment posting, collections and A/R Follow up

Internal Contacts: Solutions’ Billing Department, all affiliated Pinnacle Healthcare Divisions

External Contacts: Solutions’ Billing Clients

DIRECT SUPERVISION:

Patient Account Specialists, Customer Service Specialists

ACTING MANAGER FOR VACATION/PTO COVERAGE:

All revenue cycle employees including: Lead A/R, Lead Charge Entry Specialist, Lead Cash Applications Specialist, Customer Service, Charge Entry, Cash Applications, Accounts Receivable, Credentialing and Coding.