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Manager, Revenue Cycle Quality

2 months ago

New Hyde Park, United States Northwell Health Full time
Job Description

Job Description

Manages the revenue cycle operations of the clinical department by providing expertise in front-end best practice operations and serving as a liaison to the Clinical Practice Plan, responsibilities include the assessment of front-end operations and subsequent recommendations to improve revenue outcomes. Reviews, monitors, and assists in the explanation of monthly revenue performance against budget and benchmark criteria. Prepares revenue analysis in order to maximize reimbursement and assists in the development of the annual revenue budget. Communicates revenue performance to the department and helps in identifying/implementing improvement opportunities.

Job Responsibility
  • Provides leadership to Revenue Cycle Quality & Performance Management team members and supervisors by communicating and guiding toward achieving department objectives.
  • Develops, communicates, and builds consensus for goals in alignment with the health system.
  • Analyzes and improves the performance of front-end billing operations through development and monitoring of performance criteria related to; front end patient data acquisition and management; appointment scheduling, patient registration, insurance verification, data entry, charge and diagnosis assignment and charge capture activities; front-end billing operations key indicators, including denial trending analyses and co-pay collection.
  • Error reports, claim processing reports, accounts receivable reports and any pertinent ad hoc reports; educates department and related divisions on revenue cycle standards; provides timely feedback of key performance indicators.
  • Identifies problems in the process flow or organizational structure that impedes financial outcomes, proposes solutions, and collaborates with department to implement corrective action, including; allocation of resources related to front end function.
  • Trains front end staff related to key revenue cycle functions; availability and use of technology and automated tools that support revenue initiatives; enforces or revision of policies and procedures; performs financial management for the department.
  • Assists in the development of annual revenue projections for department; assists in the preparation of pro-forma projections to support new services and/or revenue sources; monitors the current monthly revenues and communicates results through variance reports; reviews financial performance through P&L statements, AR analysis and other reports; analyzes these variances and identifies opportunities for improved results.
  • Performs fee schedule analysis; analyzes the fee structure of the particular division and provides semi-annual fee and revenue reassessment; proposes fee structure revisions based on local, regional, and tertiary fair market pricing assessments and opportunities for net revenue improvement; supports new program development by advising on development of fee arrangements for new or special services.
  • Oversees managed care contracting and related activities for the division; analyzes current managed care contracts for the clinical department and assesses the financial impact on the practice; proposes modifications and other pertinent strategies, including plan participation, as necessary; analyzes billing administration of third party payment contracts to ensure correct billing, adjudication and payment processing and result reporting; partners with the Managed Care Contracting department performs audits and reviews, proposes and/or negotiates payer contract revisions and communicates the financial impact to the Chair and Division Chiefs.
  • Serves as liaison to central FPP office and monitors the credentialing process and plan participation status with third party payers for new and existing physicians; confirms appropriate profiling within IDX billing the health system; performs reimbursement management; analyzes payer reimbursement to ensure proper claims adjudication; monitors payment denials, reductions, and rejections to determine operational or coding problems.
  • Initiates analysis, per provider, to determine shifts in services and payer mix; assists with the development of charge documents, to ensure appropriate selection and reporting of services in compliance with coding protocols, AMA and federal guidelines and HIPAA requirements; ensures proper in-services on coding regulations; ensures the adequate communication of financial and operational results.
  • Serves as a liaison to the billing operations to resolve payment and other receivable issues; initiates, develops and presents physician and staff training programs for better understanding of the revenue cycle process; meets monthly with department to communicate progress in budget revenue performance.
  • Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.
Preferred Skills
  • Strong managerial experience if an fast paced environment
Job Qualification
  • Bachelor's Degree required, or equivalent combination of education and related experience.
  • 6-8 years of relevant experience and 2-5 years of leadership / management experience, required.


*Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).