Revenue Cycle Senior Leader

At Wellpoint Care Network, our mission is to facilitate equity, learning, healing, and wellness by restoring the connections that help children and families thrive.

Every person deserves the opportunity to reach their fullest potential. It’s part of human nature, and the promise of our country, that everyone be given a fair chance to be and do their best. Yet, many in our community live with unresolved childhood and generational trauma.  

That’s where we come in. We believe we can create a world where children and families have a clearer path to their fullest potential. Wellpoint Care Network has championed the restoration of families for nearly 175 years.

Job Purpose: 

Our next Revenue Cycle Senior Leader will be responsible for overseeing the financial flow of client services from the initial appointment to the final payment, which includes managing all the functions that contribute to revenue: insurance processing, registration, eligibility, claims management, billing, receivables, and denials. This position is responsible for resolving billing and reimbursement-related issues, which includes minimizing bad debt, improving cash flow, and effectively managing accounts receivable for the Clinical / Mental Health Services business unit. This role will also oversee client intake, Care Navigation, provider credentialing, as well as the maintenance of billing and practice management platforms.

Qualifications: 

• Bachelor's degree in health administration, finance, business, or a related field required; master’s degree in health administration or business administration with a focus on healthcare management preferred.
• Certified Revenue Cycle Representative (CRCR) or Certified Revenue Cycle Executive (CRCE) a plus.
• Minimum four (4) years of experience in healthcare billing, including Medicaid/Medical Assistance.
• Minimum two years (2) supervising staff in a client / customer service setting required; healthcare setting preferred.
• Certified coder, coding auditor, or coding education experience preferred.
• Knowledge of third-party payer requirements including federal, state, and private health care plans and authorization process.
• Knowledge of basic insurance policies, procedures, and reimbursement practices with Medicare coding.
• Demonstrates ability to work independently and effectively with staff, clients, caregivers, and purchasers.
• Must be honest, dependable, and able to meet deadlines; Self-motivated and able to work independently.
•  A valid Wisconsin Driver’s License or occupational driver’s license, reliable transportation and insurance is required. Required reliable transportation to conduct on-site learning throughout the state.
• Ability to demonstrate critical thinking skills, detail oriented, highly effective verbal, and written communication skills.
• Demonstrate an ability to effectively understand and practice cultural humility and ability to work and communicate respectfully with individuals from diverse backgrounds.
• Proficient in the usage of computer software; demonstrate an understanding of computer file systems and databases, e.g., Microsoft Office, Excel, Outlook, Teams, ADP, etc.
• Physical exam, drug screen, motor vehicle report, and background checks are required for this position.

Duties:

Administrative Management

• Oversees and manages entire revenue cycle including billing, coding, receivables, and denial management.

•Plans and directs medical insurance documentation, workload coding, billing and receivables, and data processing to ensure accurate billing and efficient account receivable.

•Participates in the development of coding and billing strategies, evaluating process relative to revenue cycle, and making recommendations while ensuring compliance with any relevant rules or regulations (including HIPAA, Medicaid, Medicare, and specific third-party payers).

Intake, Medical Billing and Receivables

• Oversees the intake process which includes providing leadership to the intake and reception department for the Mental Health Services programs.

•Establishes productive working relationship external billing company, HPI, ensuring regularly scheduled meetings are held to review tasks and ensure process changes are being performed as required. 

•Addresses quality management issues related to intake procedures and service evaluation for the clinic and/or other Mental Health programs.

Credentialing & Technology Management

• Oversees the processing of credentialing and provider enrollment applications, initial, and re-enrollment status with all Medicaid, Medicare, and commercial payors.

•Provides oversight for the management and maintenance of billing and practice management software and platforms.

•Serves as a technical resource for the EHR system.

Compliance & Risk Management

• Ensures that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.

•Ensures highest level of business and patient confidentiality possible adhering to all HIPAA and security guidelines when accessing and sharing patient information.

•Conducts revenue cycle audits and reviews to ensure practice is aligned with policies.

Supervision 

• Supervises assigned department personnel which includes the following responsibilities, but are not limited to hiring, learning, scheduling, evaluating, and ensuring accuracy, timeliness, and the completion of all work performed by direct reports. 

• Develops and implements training programs for revenue cycle staff to ensure they are knowledgeable about industry best practices, compliance requirements, and organizational policies.
• Educates direct reports on all department and company policies and procedures. 

Agency Engagement 

• The Agency is committed to the philosophy and practice of trauma informed care including the participation of all employees in an active understanding and promotion of the agency’s trauma informed care model, The Seven Essential Ingredients. 
• Participates in assigned meetings, events and learning as required.
• Other duties as assigned including serving in a coverage role for other department members.

Position Details & Extras:

• Full time.
• Onsite / Hybrid work is available with reliable broadband connection.
• Fast-paced, flexible work schedule includes evenings and some weekends to accommodate program needs.
• Moderate exposure to noise.
• Subject to frequent interruptions with ability to manage multiple tasks simultaneously.
• Demonstrates an understanding of the cultural differences among diverse groups and the need to adapt service provision to match these differences in respectful ways.
•  Public Service Loan Forgiveness (PSLF) - Wellpoint employees may be eligible for loan forgiveness under the Public Service Loan Forgiveness program. 
• Regular travel in personal vehicles is required with the ability to move intermittently throughout the workday.
• Willingness to work beyond normal working hours: evenings, nights, and weekends.

Organizational Information: 

At Wellpoint Care Network, we have seen exactly how trauma, poverty, systemic racism, social injustices, and other barriers create instability in all areas of life. The people in our care face education and health disparities, high unemployment rates and unaffordable housing. What’s worse, many have lost connections to resources, family, friends, and other support systems. We have seen the toll it has on a person’s physical, emotional, and financial well-being to try and successfully navigate complex systems that may have failed them in the past.

We believe there is a better way. So, we have anchored ourselves in our 170 years of caring for our neighbors through modernized human services.

Wellpoint Care Network provides a rich continuum of services, including:

•        Child Welfare and Foster Care 

•        Support for youth who have aged out of care

•        Care Coordination and Wraparound services 

•        Mental health therapy and supports such as our Clinic, Family Preservation, Caregiver Support, and Integrated Community Treatment

•        Professional education and clinical consultation (for organizations, schools, and individual/family) 

Wellpoint Care also works to promote a diverse and caregiving environment to ensure that those we serve and employ are valued, accepted, respected, and treated equitably.

•        Equity means we work tirelessly toward fair and just treatment, systems, and policies. At Wellpoint Care Network, we believe that we are accountable – individually and collectively – when inequity or injustice replaces equity and inclusion. 

•        Inclusivity means that we consciously build groups that welcome and celebrate differences in age, race, ethnicity, class, gender, sexual orientation, religion, gender expression, education, socio-economic background, personal history, geographical location, marital status, parental status, and work experiences.   

Interested parties please apply online. We are committed to enhancing diversity, equity and inclusion and strongly encourage minority candidates to apply. For more information, visit our website www.wellpointcare.org.

Equal Opportunity Employer