Revenue Cycle Manager, Procedural Areas
1 day ago
MedStar Health is seeking a highly skilled Revenue Cycle Manager, Procedural Areas to oversee revenue cycle services, billing, and coding for the Cardiac-Arrhythmia Center. This role is responsible for managing all business-related revenue cycle operations, including effective and compliant patient and procedural scheduling and registration, billing functions, and third-party reimbursement and payment reconciliation.
Key Responsibilities- Develop and implement policies and procedures relating to revenue cycle functions of procedural areas and other assigned areas.
- Manage daily facility billing entry and reconciliation for procedural areas, reviewing missing charge reports and following up with providers and staff as needed.
- Oversee billing/charge entry staff and work with department directors to handle personnel-related activities, including hiring, termination, and evaluation of administrative/clerical staff.
- Educate and provide direction, training, and support to providers and coding/billing staff on systems related to patient care, accurate charge capture, documentation, and billing submission for procedural areas.
- Work with Compliance to meet auditing requests and resolve queries.
- Maintain current knowledge of reimbursement optimization methods for all payors and implement procedures to improve collections and reduce insurance accounts receivable (IAR) days.
- Responsible for maximizing revenue, including insurance verification and eligibility, insurance authorizations, collections of payments, and reconciliation of charges.
- Maintain strong relationships with MWHC finance department, Patient Financial Services (PFS), Revenue Control, and PUBS.
- Initiate billing policies and procedures for assigned departments, conduct charge audits, identify inconsistencies, billing errors, and missing charges, and analyze results of audits including denials.
- Identify reimbursement problems and/or trends, develop and implement solutions, and resolve problems to ensure reimbursement for procedural areas.
- Audit documentation and coding to ensure accuracy and legitimacy, working with department directors and the Compliance Office to meet audit requests and re-train physicians as needed.
- Conduct annual code and fee reviews and ensure encounter forms are updated.
- Participate in the clinical value analysis team and be responsible for revenue cycle analysis of new procedures and products in both inpatient and ambulatory settings and maximize reimbursement.
- Develop performance evaluation standards and objectives, monitor and evaluate staff performance, ensure training and development of staff, and resolve staff grievances to ensure compliance with Hospital contractual stipulations.
- Manage system-wide procedural denials for facility, including analysis of root cause and development of prevention process, and manage appeals for outpatient and acute care claims.
- Provide oversight on facility Coding and Device edits management.
- Maintain oversight of supply add process for routine related items requiring CMS approval letter as well as appropriate CPTs and price mark-up.
- Associate degree required; Bachelor's degree in business or health care related field preferred.
- 3-4 years of progressively more responsible job-related experience required.
This position has a hiring range of $80,995 - $144,102.
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