Revenue Cycle Management Professional

1 week ago


Binghamton, New York, United States Care Compass Network Full time

Care Compass Network seeks a seasoned Revenue Cycle Manager to oversee the financial operations of our 1115 Waiver Social Care Network. This key role will ensure seamless claims processing, billing, and reimbursement activities while maintaining compliance with New York State Medicaid regulations.

Key Responsibilities:
  • Develop and execute a comprehensive revenue cycle strategy for the SCN, encompassing member eligibility assessment, billing, coding, collections, and denial management.
  • Communicate effectively with stakeholders, including payers, community partners, and SCN governance.
  • Manage and maintain the billing function of the SCN IT Platform.
  • Provide ongoing education on billing and coding best practices to the SCN Finance Team and community-based organizations.
  • Develop, evaluate, and implement policies and procedures related to billing, coding, and reimbursement activities.
  • Reconcile receivables and revenue reports, working closely with the Finance Department to produce accurate monthly financial statements.
  • Ensure fee schedules are up-to-date in accordance with New York State guidance.
  • Resolve claim generation and rejected/denied billing issues in eMedNY.
Requirements:
  • Bachelor's degree required; 3-5 years of relevant work experience.
  • Prior experience in process development and execution.
  • Strong communication skills (written and verbal).
  • Negotiation skills and ability to build strong working relationships.
  • Experience with various coding structures, including ICD-10 Z-Codes, SNOMED, LOINC, HCPCS.
  • Proficient in planning & time management.
  • Ability to work independently with minimal supervision.
  • Critical thinking/problem-solving skills.
  • Attention to detail.
  • Familiarity with Microsoft Office Suite, Tableau, and/or PowerBI.
Preferred Qualifications:
  • Experience with New York State Medicaid claims billing, regulations, and claims management functions.
  • Familiarity with ICD-10 'Z codes', SNOMED-CT, HCPCS, and NYS Modifiers.
Benefits:
  • Ongoing professional development opportunities.
  • A competitive salary range: $85,000 - $110,000 per year, depending on experience.
  • A comprehensive benefits package, including medical, dental, and vision insurance.
  • A generous paid time off policy, including vacation, personal, and sick leave.
  • A 401(k) plan with company match.


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