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Revenue Cycle Operations Manager
2 months ago
Position Summary:
The Revenue Cycle Operations Manager plays a crucial role in overseeing the organization's financial processes related to revenue generation. This position is tasked with supervising the billing team's workflow, delivering training and educational resources to both management and staff concerning revenue cycle practices. The manager is responsible for all aspects of the billing and revenue cycle functions to enhance cash flow while ensuring high-quality customer relations.
Key Responsibilities:
- Oversee daily operations of the revenue cycle and billing personnel.
- Assist in the formulation and enforcement of revenue cycle policies and procedures.
- Regularly communicate effective strategies for enhancing the revenue cycle process to Clinic Managers, staff, and billing partners.
- Initiate continuous improvement efforts and innovative applications of billing software, focusing on increased automation.
- Manage the PM system for optimal functionality, including adherence to protocols, updates, reporting, and software enhancements.
- Develop automation solutions for billing and reporting tasks.
- Ensure timely completion of month-end closing and reporting, producing precise monthly revenue cycle reports.
- Research, recommend, and lead the implementation of revenue cycle enhancements.
- Ensure compliance with Federal, State, and payer regulations, including UDS reporting.
- Verify that new offices are properly licensed and compliant for operation, and that existing sites maintain current state and federal licensure.
- Oversee the credentialing process for providers and staff.
- Identify trends in denials and billing errors through analysis of Days in AR and other metrics, reporting findings to the CFO.
- Stay informed about FQHC billing and operational practices.
- Ensure exceptional customer service to both internal and external clients, adhering to standards set by Open Door Health Center.
- Design and implement ongoing revenue cycle training programs for all personnel.
- Provide necessary projections and reports for budget development and management.
- Maintain current knowledge of CPT, ICD-10, and HCPCS guidelines.
- Monitor the efficiency of departmental activities, ensuring outstanding patient accounts and accounts receivable remain within agreed limits and that bad debt stays within budgetary targets.
- Compile and prepare various status reports for management to analyze trends and make informed recommendations.
- Collaborate with leadership to introduce new programs and services that address the needs of identified populations.
- Assist the Human Resources Department with the credentialing and re-credentialing of all licensed personnel.
- Maintain an accurate internal provider grid to ensure all information is correct and accessible.
- Keep provider profiles up to date on CAQH and all relevant databases.
- Complete revalidation requests from government payers.
- Perform additional tasks as assigned.
Qualifications and Skills:
- Bachelor's degree or equivalent in business, accounting, or a related field.
- A minimum of three years of experience in healthcare management, including clinic management, patient management, and accounts receivables/payables.
- Strong financial management background with knowledge of federal and state laws related to healthcare management.
- Proven managerial skills in leadership, team development, coaching, mentoring, and situational assessment, with a track record of building high-performing teams.
- Bilingual abilities are advantageous.
Additional Requirements:
Travel may be necessary for meetings, events, and to support various clinic locations within the community and region. Travel expenses will be reimbursed according to the organization's policy. The position requires the ability to sit for extended periods and involves repetitive use of fingers, hands, and wrists for job-related tasks, such as using a telephone and computer. A complete range of motion, including fine motor skills and tactile sense of both hands, is necessary. The ability to lift up to 25 pounds is also required. This document outlines the general nature and level of work performed and is not intended to serve as an exhaustive list of all duties, skills, and responsibilities.