Revenue Cycle Manager

4 weeks ago

Gilbert, United States SG HOMECARE INC Full time
Job DescriptionJob DescriptionDescription:

Position Overview

The Revenue Cyle Manager will manage patient billing and insurance claims for a medical facility. Your job duties include creating reports, analyzing data, identifying lost revenue, collecting payments, and implementing revenue cycle management (RCM) strategies to minimize losses. The position defines and provides necessary support and leadership to achieve department goals and objectives. Provides oversight and functions as it relates to managing all aspects of the Revenue Cycle including, but not limited to billing and claims follow-up, collections, revenue integrity, and all other matters related to accounts receivable. Serves as a subject matter expert on contemporary best practices for revenue cycle workflows, team integration, and excellence in achieving executive goals. To be successful as a revenue cycle manager, you should be able to manage both staff and patient complaints. Ultimately, a top-performing revenue cycle manager should seek ways to improve the functioning of the revenue cycle department.

Job Duties and Responsibilities:

  • Coordinate billing and collection activities.
  • Monitor accounts receivables activity.
  • Oversee monthly closing processes, including reporting and account balancing.
  • Ensure accurate billing of insurance providers and patients.
  • Document medical billing denials from insurance providers.
  • Evaluate billing processes and procedures.
  • Train new staff members

· Strong knowledge of medical billing, Medicaid, and Medicare.

· Excellent problem-solving skills and interpersonal skills.

· Achievement of annual and periodic goals for key performance metrics of revenue cycle performance and the organizations overall financial performance while ensuring consistent, compliant billing practices in conjunction with all governmental regulations and other third-party payer requirements.

· Understands, develops, implements, and analyzes key performance measures for continuous improvement. Identifies specific trends or issues and communicates status and resolution with leadership.

· Review and assess the billing and receivables infrastructure, processes, and workflows to continue the organization’s progress toward enhanced accountability and consistency, patient safety, and patient satisfaction.

· Leads process improvement and optimization initiatives to achieve best practices and positively impact net revenue and cash flow performance.

· Maintains contemporary working knowledge of all market payor agreements and works with Leadership when negotiations require revenue cycle contribution.

· Establishes a culture of excellence and responsiveness expectations for self and others.

· Demonstrates expectations through own actions and ensures professional leadership is maintained.

· Manages the filing and resolution of claims with individual carriers or agencies.

· Manages the collection of accounts, the maintenance of the Medicare bad debt, and the outsourcing of account receivables following appropriate protocols.

· Maintains knowledge of all workflows related to outsourced functions of the revenue cycle department.

· Manage revenue cycle vendor relations to ensure optimal operational efficiency.

· Provides reporting to support monthly financial statement preparation.

· Supervises, trains, and mentors assigned personnel. Evaluate performance and recommend merit increases, promotions, and disciplinary actions.

· Manages the department within the established budget as related to personnel.

· Manages updates to the contract matrix with accurate terms and fee schedules and establishes a common reimbursement grid by procedure code.

· Serves as a knowledgeable resource in resolving insurance claim processing issues.

· Monitors changes in the medical insurance industry and adjusts procedures accordingly.

· Reviews and evaluates third-party claim policies and procedures for insurance plans, and develops new procedures to improve the quality and quantity of work processed.

· Maintains knowledge of and complies with established policies and procedures.

· Initiates and answers pertinent correspondence. Prepares and writes reports. Maintains required records and files.

· Attends required meetings and participates in committees as requested.

· Participates in professional development activities and maintains professional affiliations.

· Implementing a system to ensure that accurate billing information is entered into the billing system.

· Managing staff performance by providing regular feedback, performance reviews, and one-on-one meetings.

· Develops, evaluates, implements, and revises policies and procedures related to billing,

coding, reimbursement activities and improvement strategies

· Reconcile all receivables and revenue reports and work closely with the finance

department in the development of the monthly financial statements

· Efficiently managing patient complaints in respect of billing and collections.

· Planning and structuring the department workflow and staffing

· Maintains patient confidentiality.

· Reviewing financial hardship applications.

· Overseeing the hiring and training of staff.

· Other duties as assigned.

Requirements:

Requirements and Qualifications:

  • 4-7 years of experience in medical billing
  • 2-4 years of Supervisory experience preferred
  • Knowledge of HIPAA regulations
  • Computer, analytical, and organizational skills
  • Must have knowledge of medical practice operations, with preference in the area of DME.
  • Billing/collection practices and methodologies.
  • Basic coding, CPT, diagnosis, and HCPCS codes.
  • Third-party payer procedures practices and contracts.
  • Governmental legal and regulatory provisions related to billing and collection activities.
  • Data analysis, systems design, problem identification, and medical data processing practice.
  • Skill in establishing and maintaining effective working relationships with other employees, patients, physicians, insurance organizations, and the public.
  • Computer applications.
  • Analytical and statistical reporting.
  • Use of Excel spreadsheets for monitoring statistics.
  • Communicate clearly and follow written and oral instructions.
  • Resolve conflicts productively.
  • Manage and mentor supervisory staff.

Physical Demands and Working Environment

The conditions herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

Environment: Standard office setting; tasks are regularly performed without exposure to adverse environmental conditions; frequent interaction with staff and the general public.

Physical: Incumbents require sufficient mobility to work in an office setting; stand or sit for prolonged periods of time; operate office equipment including use of a computer keyboard; light lifting, carrying, pushing and pulling; ability to verbally communicate to exchange information.

Vision: See in the normal visual range with or without correction; vision sufficient to read computer screens and printed documents; and to operate assigned equipment.

Hearing: Hear in the normal audio range with or without correction.

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