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Accounts Receivable Operations Manager

2 months ago

Birmingham, Alabama, United States Complete Health group Full time

Position Overview:
The Accounts Receivable Operations Manager is responsible for overseeing and coordinating the daily billing functions within Complete Health's physician practices. This role is essential for optimizing cash flow while enhancing relationships with patients, physicians, stakeholders, and other clients.

Key Responsibilities:
- Manage the stewardship of Patient Billing and Collection processes.
- Oversee Accounts Receivable Management and Application Systems Support.
- Ensure effective Claims Management, Coding, Charge Capture, and Data Entry.
- Lead Account Follow-Up, Customer Service, Denial Management, Edit Management, and Payment Variance Analysis.
- Conduct Contract Analysis, Credit Analysis, Refund Management, and Payment Posting.
- Perform Auditing, Training, and generate Productivity and Performance Reports.

The Manager plays a pivotal role in maintaining the integrity of the Group Practice Revenue Cycle and streamlining workflow processes. Compliance Assurance:
Ensure that all billing systems and workflow processes meet established requirements for timely and optimal reimbursement.

Performance Improvement:
Develop regular business operations reports and enhance Revenue Cycle efficiency through analysis of key performance indicators.

Strategic Recommendations:
Advise on changes that will positively influence the Revenue Cycle and help the Central Business Office align with industry benchmarks while achieving A/R performance goals.

Essential Functions:
- Oversee the operational performance of the Central Business Office (CBO) to support Revenue Cycle objectives.
- Ensure compliance with Federal, State, and payer regulations in all CBO billing operations.
- Implement and monitor adherence to billing, collection, and refund policies and procedures.
- Analyze Revenue Cycle activities to identify needs for procedural enhancements and participate in system design and implementation.

Engage in monthly meetings with Department Administrators and Operations to provide insights on Revenue Cycle management. Prepare reports and presentations to support these discussions.

Communication and Support:
Facilitate effective communication between Central Business Office staff, Front-End personnel, and Department Administrators to promote ongoing education and expedite problem resolution.

Assist in financial analysis for the company, group, and department. Collaborate with Clinic sites and practice managers to develop action plans for improving operations and addressing challenges in Revenue Cycle processes.

Training and Development:
Contribute to the creation of training manuals and job aids for relevant areas of expertise. Conduct assessments of change readiness and present findings clearly.

Participate in research and assessment of new services or business lines, providing analytical support for reporting and identifying opportunities for revenue enhancement.

In collaboration with the Revenue Cycle Director, support Complete Health's growth initiatives and clinical programs by ensuring timely delivery of provider and system setups.

Minimum Qualifications:
- Bachelor's degree preferred.
- Certified Professional Coding Certificate from AAPC is a plus.
- Minimum of 5 years of experience in healthcare Revenue Cycle management required.
- Knowledge of accounts receivables, billing systems, coding, and revenue management analysis is essential.
- 2-3 years of management experience in Practice Management or Revenue Cycle Management preferred.
- Familiarity with physician billing in a primary care setting is advantageous.
- Advanced understanding of third-party insurance and various insurance plan types (HMO, PPO, POS, Indemnity).
- Proficient knowledge of EHRs and Physician Billing Systems, with Athena experience preferred.
- Comprehensive understanding of Commercial, Medicare, HMO, and PPO Programs, particularly regarding CPT procedures and ICD-10 coding.
- Strong knowledge of Medicare Fraud and Abuse regulations.
- Excellent customer service skills, with the ability to counsel patients regarding outstanding charges.
- In-depth knowledge of HIPAA regulations.