Revenue Cycle Operations Manager

1 week ago

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

The Revenue Cycle Operations Manager will report directly to the Finance Director of Care Compass Network, overseeing the financial processes related to enhanced service claims and payments within a collaborative network of community organizations. This role is crucial in managing claims submitted by the Social Care Network to third-party payers, as well as processing claims from Community-Based Organizations.

Key Responsibilities:
  • Oversee the complete revenue cycle for the 1115 Waiver Social Care Network, including member eligibility assessments, billing, coding, collections, and denial management.
  • Engage professionally with a variety of stakeholders, including payers, community partners, and governance bodies of the Social Care Network.
  • Manage and maintain the billing functions within the SCN IT Platform.
  • Provide ongoing education on billing and coding practices to the SCN Finance Team and participating community organizations.
  • Develop, assess, implement, and revise policies and procedures concerning billing, coding, reimbursement activities, and improvement strategies.
  • Reconcile receivables and revenue reports, collaborating closely with the Finance Department to produce monthly financial statements.
  • Update fee schedules in accordance with the latest guidance from New York State.
  • Address and resolve issues related to claim generation and rejected or denied billings.
  • Uphold the highest standards of business and patient confidentiality, adhering to HIPAA and security protocols when handling patient information.
  • Maintain robust internal controls over accounts receivable and payable activities for Social Care Network billing.
  • Prepare necessary reports for New York State or other payer audits and compliance requirements.
Qualifications:
  • Education: Bachelor's degree required, with 3-5 years of relevant experience.
  • Demonstrated experience in process development and execution.
  • Strong written and verbal communication skills.
  • Ability to negotiate and foster strong working relationships.
  • Familiarity with various coding structures, including ICD-10 Z-Codes, SNOMED, LOINC, and HCPCS.
  • Proficient in planning and time management.
  • Ability to work independently with minimal supervision.
  • Utilizes critical thinking and problem-solving skills effectively.
  • Exceptional attention to detail.
  • Proficient in Microsoft Office Suite (Word, Excel, PowerPoint) and familiarity with Tableau and/or PowerBI is advantageous.
  • Experience facilitating meetings in person or via virtual platforms.
  • Preferred: Experience with New York State Medicaid claims billing and regulations is highly desirable.
  • Preferred: Knowledge of ICD-10 'Z codes', SNOMED-CT, HCPCS, and NYS Modifiers.
Licensure/Certification:
  • Minimum Required: N/A
  • Preferred: Certification as a coder, coding auditor, or experience in coding education.
Work Environment:

This position operates within a hybrid work model, allowing for remote work or office-based work in a professional setting. Some travel may be required for meetings with partners or network stakeholders.

Benefits:
  • Comprehensive benefits package including Medical, Dental, and Vision coverage.
  • 401(k) plan with matching contributions.
  • Competitive salary structure.
  • Generous paid time off policy including holidays, vacation, personal, and sick leave.

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