The Revenue Cycle Manager will coordinate and direct all aspects of the billing, coding, accounts receivable, denial and payment posting activities to ensure maximization of cash flow while improving patient, provider and other customer relations.
- Participates in interviewing, selecting, hiring, and onboarding staff.
- Oversees the day-to-day operations and work assignments of staff.
- Provides training, advice, and direction for staff.
- Delivers regular performance feedback and constructive performance evaluations; follows established disciplinary and termination procedures as needed.
- Ensures staff adhere to and follow all organizational policies, safety standards, and healthcare regulations.
- Develops and implements policies, procedures, and operational benchmarks for standardization of best practices.
- Supervises and develops Revenue Cycle team members
- Monitors billing and collection work queues for account activity, aging and employee productivity as well as quality of work. Creates an effective work plan to reduce A/R and drive results.
- Ongoing process improvement analysis; and implementation of system improvements. Oversight includes all activities within the scope of the Revenue Cycle Department including coding, charge/data entry, cash posting, insurance follow-up, and billing and collection of patient balances.
- Perform ongoing trend analysis of payer rejections and denials. Identifies deficiencies in the reimbursement process and opportunities for appropriate reimbursement. Actively seeks opportunities to improve financial outcomes, engaging staff in the process
- Perform proactive audits on all recommended A/R write offs and present audit results to Director.
- Manage work related to EHR vendor on Electronic Interchange (EDI) and Clearinghouse issues and system upgrades to maximize practice management system utilization.
- Serves as a liaison for the providers of health care services, patients or other responsible persons, and revenue sources to ensure the accuracy of charge; works directly with providers, clinic teams and other to reduce clinical and coding denial impact to the organization.
- Ensures financial controls, identifies trends, patterns, and opportunities to increase reimbursement, and improves processes.
- Makes recommendations for improvements in processes or policies and create/execute provider education for individuals and/or group sessions.
- Maintains audit results and ensures provider movement throughout the compliance audit plan; analyzes and confirms results, and as appropriate, work with leadership to create action plans.
- Ensures knowledge of and compliance with organizational policies and protocols and regulatory requirements; educates staff on changes.
- Acts as a subject matter expert to all departments, clinical leaders and physicians as it relates to CMS, and State medical record documentation, Coding and Billing guidelines.
- Establishes and monitors refund process productivity standards and ongoing efforts, monitors the refund approval process and account aging with established standards in mind, monitors the Medicare Credit Balance report preparation ensuring that Medicare credits are concurrently identified and corrected, maintains a continuous quality improvement program to insure a productive work flow, and develops and insures compliance with all policies and procedures utilizing available reporting mechanisms.
- Assists IT Analysts with enhancing computer systems electronic billings and collections, control procedures and efficiency of intra-company communications.
- Attends, participates, and/or assists in meetings, trainings, community outreach activities, continuing education opportunities, and other activities as required.
- Performs other related duties as assigned.
- Strong leadership skills.
- Demonstrated ability to foster a One Team approach
- Strong medical terminology.
- Ability to maintain confidentiality.
- Ability to read, interpret, and apply regulations, policies, and procedures.
- Ability to coordinate functions and work cooperatively with others.
- Ability to use and access database computer applications.
- Ability to organize work and set priorities to meet deadlines.
- Strong problem-solving skills and ability to make timely decisions
- Strong attention to detail
Education and Experience:
- Bachelor’s degree or equivalent work experience required, Healthcare or related field highly preferred.
- Certified Coder with one of the following in active status (CPC, CCS, COC or CMC) required.
- Certified Risk Adjustment Coder (CRC) strongly preferred.
- 4+ years of healthcare billing and coding experience required; medical office setting preferred.
- 3+ years of supervisory experience required.
- 3+ years of billing and/or coding experience in a FQHC environment highly preferred.
- 1+ years of EPIC EHR experience highly preferred.
- Prolonged periods sitting at a desk and working on a computer.
- Ability to walk, stand, lean, bend, reach, stoop, kneel, crouch, and squat.
- Close vision (clear vision at 20 inches or less).
- Able to hear adequately to decipher spoken word, sounds, alarms, etc.
- Able to express or exchange ideas by means of spoken word and to convey detailed spoken instructions to other workers accurately and clearly.
- Able to use hands and fingers for fine manipulation to touch, pick, pinch, and grasp and perform repetitive motions.
- Must be able to lift up to 15 pounds at times.
- Must be able to navigate various departments of the organization’s physical premises.
- New Hires are required to pass pre-employment background check and drug testing (effective 11/1/2022).
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