Revenue Cycle Operations Leader

1 week ago

Mankato, Minnesota, United States Open Door Health Center Full time
Job Overview

Position Summary:

The Revenue Cycle Manager plays a pivotal role in overseeing the organization's revenue cycle operations. This position entails monitoring and optimizing the workflow of the billing team, as well as providing essential training and education to both management and staff regarding revenue cycle processes. The Revenue Cycle Manager is tasked with managing all aspects of the billing and revenue cycle functions to enhance cash flow while ensuring high-quality internal and external 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.
  • Drive continuous improvement and innovative utilization of billing software, focusing on increased automation.
  • Manage the PM system to ensure efficient and effective use, including protocol enforcement, updates, reporting management, and software enhancements.
  • Proactively develop automation solutions for billing and reporting tasks.
  • Ensure timely completion of month-end close and reporting, delivering accurate 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 management of Days in AR and other billing metrics, communicating findings to the CFO.
  • Maintain knowledge of FQHC billing and operational practices.
  • Ensure superior customer service to both internal and external clients, adhering to standards set by Open Door Health Center.
  • Develop and facilitate ongoing revenue cycle training for all personnel.
  • Provide necessary projections and reports for budget development and management.
  • Stay updated on current CPT, ICD-10, and HCPCS guidelines.
  • Monitor the timeliness and effectiveness of departmental activities, ensuring that outstanding patient accounts and accounts receivable remain within agreed limits and that bad debt stays within budgeted targets.
  • Compile and prepare various status reports for management to analyze trends and make informed recommendations.
  • Collaborate with leadership to implement 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 staff.
  • Maintain an accurate internal provider grid to ensure all information is current and accessible.
  • Keep provider profiles on CAQH and other relevant databases accurate and up to date.
  • Complete revalidation requests from government payers.
  • Perform additional tasks as assigned.

Qualifications:

  • 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 and payables.
  • Strong financial management background with knowledge of federal and state laws and requirements related to healthcare management.
  • Proven managerial competencies in leadership, team development, coaching, mentoring, and situational assessment, with a track record of building high-performing teams.
  • Bilingual skills are advantageous.

Additional Requirements:

This position requires travel to meetings and events, as well as support for other clinic locations within the community and region. Travel expenses will be reimbursed according to the organization's travel policy. The role necessitates the ability to sit for extended periods and involves repetitive use of fingers, hands, and wrists in job-related tasks, such as using a telephone and computer. A complete range of motion, including fine motor skills and tactile sense in both hands, is essential. The ability to lift up to 25 pounds is also required. This document serves to outline the general nature and level of work performed and is not intended to be an exhaustive list of all duties, skills, and responsibilities.

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