Revenue Cycle Manager
Reporting to the Director of Finance, the Revenue Cycle Manager is responsible to develop, plan, organize and implement current and future strategies to bill insurance payers and customers, process claims and payments, minimize bad debt, improve cash flow and manage the overall health of the receivables. Work with leadership to improve and automate workflows.
· Develops policies, guidelines, and implementing procedures and ensures consistent department implementation.
· Identify revenue cycle problems and implement solutions for improvement.
· Assists with workflow management of the revenue cycle staff including billing specialists, authorization and verification and front desk personnel.
· Maintains open communication with Director of Finance, regarding contractual issues, denials management, and claims assessment.
· Provides projections and reports as required; produce and analyze monthly reports that assist in the monthly forecast process.
· Monitors timeliness and effectiveness of department activities, ensuring that outstanding patient accounts and accounts receivables is no more than the agreed upon limit and that bad debt is within budgeted target.
· Monitors effectiveness of collection efforts and maintains insurance billings are current within the established time frames.
· Compiles and prepares various status reports for management in order to analyze trends and make recommendations.
· Enhance, automate, and standardize work-flow processes throughout the revenue cycle to assist in achieving consistency, and align with strategy and supporting a culture of collaborations, transparency, certainty, and operational excellence.
· Provides monthly reports of productivity, days in AR, clean claim rates, denials management.
· Delineates, defines, and streamlines various functional activities, thereby ensure its effectiveness in maximizing the utilization of both asset and people resources.
· Adheres to and implements the philosophy of “hiring the best fit” and ensures that prospective employees’ personal values are aligned with our core values.
· Implementation of all Revenue Cycle team plans, programs, and projects strictly adhering to prescribed deadlines and schedules.
· All communications and relevant information pertaining to the team are cascaded to the proper channels within the team in particular, and the organization in general.
· Create and run reports to analyze billing and accounts receivable trends and report on the progress, results, and conclusions reached regarding:
- Timely billing of services
- Collection of services billed
- Aging of outstanding accounts receivable
- Unbillable services
- Write-offs or adjustments resulting from payor denials or rejections
· Analyzes financial and operational data/performance metrics, communicates findings and risks, and makes suggestions to improve processes.
· Performance coaching for the staff who failed to perform and deliver the prescribed and committed level of performance output and standards.
· Performance counseling staff with behavioral/attitudinal problems. Implements the necessary guidelines on discipline management for erring employees, in accordance with policies, rules and regulations, due process, and government regulations.
· Performance mentoring for high potential staff, capable of assuming bigger responsibilities in the future.
· Designs and develops training programs that are relevant and necessary for the continuous development of the technical competencies of the team.
· Recommends and implements for appropriate training programs that will further enhance and hone the technical competencies of the staff.
· Conducts training programs and acts as subject matter expert on training programs pertaining to the Revenue Cycle team.
· Manages overall revenue cycle including but not limited to electronic insurance verification, charge entry, claims submission, claims processing, claims rejection management and resolution, management of appeals, proper charting and documentation requirements, Charge entry – including proper Coding, Acceptance and turnaround time by carrier, Payment Posting and contractual variance monitoring, patient AR management, statements, follow up calls and letters, and 3rd party AR turnover and management.
· Oversees compliance with organizational policy and procedures, and the requirements of regulatory agencies and sponsors, including financial conflict of interest, federal effort reporting, debarment and suspension, human research protection (IRB), federal equipment management, and procurement standards
· Document issues with resolutions and share with team members to improve team productivity
EDUCATION / EXPERIENCE
· High School Diploma (Bachelor degree preferred)
· Minimum of 5 years’ experience in health care management such as but not limited to billing, claims management, clinic management, staff accountant, accounts receivables
· Knowledge and acquired usage of Microsoft standard programs; in particular, Microsoft Excel, Access, Visio, Word
· Good communication skills, particularly with inter-departmental communications
· Verbal and written communication skills
· Professional personal presentation
· Standard PC usage
· Office organization
· Internet - using the internet for filing claims, gathering information, and communicating
· Spreadsheets – knowledge and ability to create, modify, and electronically transmit
· Email and fax machine knowledge and familiarity
· Technical communication with payers and provider representatives
· Desktop computers
· Fax machine
· Copy Machine
· Postage Meter
- Microsoft Word and Excel
- Adobe Pro
- IMS (program software) – onsite training
Long Term Disability Insurance
403b Retirement Plan - 5% employer contribution after a year
COVID-19 vaccine required
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