Revenue Cycle Operations Leader
2 weeks ago
Under the direct oversight of the Billing Operations Manager, the Revenue Cycle Operations Leader is tasked with evaluating both incoming and outgoing revenue streams while executing advanced, intricate levels of technical and analytical reporting. This role will directly supervise third-party Billing Representatives and is accountable for regularly reviewing outstanding aging to identify trends and allocate workloads to staff as necessary. The primary objective of the Revenue Cycle Operations Leader is to enhance the efficiency, quality, and financial results of the third-party Revenue Cycle.
KEY RESPONSIBILITIES
Ensures sufficient staff coverage to fulfill departmental requirements, including hiring and terminating personnel in collaboration with the Billing Operations Manager. Conducts recruitment and performance evaluations as needed for direct reports.Projects anticipated revenue, reconciles projected earnings with payment receipts, organizes, and analyzes requested data for both internal and external departmental staff. Presents collected data and escalates issues to higher management when necessary.Conducts regular meetings with all direct reports, providing guidance and direction for daily claims activities related to claim submission, denial management, and outstanding accounts receivable.Guarantees the integrity and promptness of payments received from all pay sources, identifying and investigating deficiencies and inconsistencies for escalation and resolution.Develops and utilizes analytical reports from the clearinghouse to guide denial management and assist the team in efficiently managing receivables. Reviews denials and outstanding aged receivables to identify and assign workloads to Billing Representatives based on various data points on a daily, weekly, and monthly basis.Actively participates in the development of new programs and coding within the Electronic Health Records systems. Ensures that billing and payments for new programs or coding/guidelines comply with directives from pay sources.Serves as a liaison between the Billing department and program staff, vendors, and payer representatives. Establishes and nurtures relationships to enhance communication and processes.Attends necessary training sessions and conferences, which may involve occasional travel.Analyzes and investigates trends in denials and aging to determine causes and potential solutions. Communicates findings and formulates a plan for resolution under the guidance of the Billing Operations Manager, assisting in the execution of the plan.Conducts regular audits of claims processed by Billing Representatives to ensure effective claim management, tracking weekly productivity metrics; compiled data will be reviewed by the Billing Operations Manager.Proactively raises claim processing concerns with management.ADDITIONAL DUTIES
Creates and maintains real-time workflow instructions as assigned.Assists in the training of new staff and cross-training of existing staff on responsibilities as required by management.Performs other duties and undertakes projects as assigned by the Billing Operations Manager or Director of Revenue Cycle Management.QUALIFICATIONS
Associate's degree or 3-5 years of prior experience in healthcare revenue cycle analysis (if no degree) preferred.2-3 years of management experience.Ability to resolve conflicts and delegate tasks within the scope of work.Ability to schedule, meet, and maintain daily and monthly routines while preserving the integrity of the Electronic Health Records.Ability to identify team objectives and assess progress, in addition to coaching team members to achieve these objectives.Extensive knowledge of medical insurance and a comprehensive understanding of managed care products (HMO, PPO, ACO, etc.), as well as billing and collections involving CPT, ICD-10, and HCPC coding and medical terminology.Understanding and ability to read and edit 5010 HIPAA transaction standards, including but not limited to 837, 999, 277, and 835 file types.Proficient in Microsoft Office applications with strong skills in Excel (VLOOKUPs, pivot tables, formulas, etc.).Highly detail-oriented with strong analytical and problem-solving abilities.Strong analytical and problem-solving skills.APPLICATION PROCESS
If you are interested in this opportunity, please click 'Apply for Job' below or visit our website and click on "Browse All Jobs" to apply.
BHN is committed to social justice and diversity and strongly encourages diverse candidates to apply.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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