Revenue Cycle Manager

POSITION TITLE: Revenue Cycle Manager

LOCATION: HOPE Clinic - Main

REPORTS TO: Chief Financial Officer

EDUCATION: Bachelor's degree from four-year college or university, and/ or 5-7 years of experience in lieu of

WORK EXPERIENCE: One to two years supervisor experience and/or training; and FQHC experience a plus

SALARY RANGE: DOE

FLSA STATUS: Exempt

POSITION TYPE: Full-Time

LANGUAGE: Fluent in English; Bilingual in English and Spanish, Arabic, Burmese, Chinese or other languages is preferred

HOPE Clinic provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

JOB SUMMARY:

As the Revenue Cycle Manager for HOPE Clinic, you focus on partnering with our patients to clearly understand their institutional goals, challenges, organizational structure, and key business drivers. The role of the Revenue Cycle Manager oversees the Billing and Insurance Verification team's daily activities and follows up with teams to drive the overall performance and daily management of multiple assigned providers' schedules. The Revenue Cycle Manager serves as a liaison between the Billing and Insurance Verification team and other HOPE Clinic departments and the patients.

MAJOR DUTIES & RESPONSIBILITIES:

• Manage overall medical billing operations such as ensuring effective flow of demographic changes and payment information, claims accuracy and timely submission, and account reconciliations;
• Oversee aggressive follow-ups with accounts receivables (A/R), including preparation of denial appeals and distribution of patient statements;
• Track fee schedules and insurance denials to ensure fully allowed reimbursements;
• Identify and implement strategies to improve internal and patient billing processes;
• Incorporate and execute quality assurance processes related to ensuring accurate patient billing activities;
• Review and analyze patient accounts, identify trends and issues, and recommend solutions;
• Collaborate with other team members to improve/maintain an overall positive work environment for the team;
• Provide a high level of customer service to both practices and patients by identifying and efficiently resolving insurance and other billing-related issues;
• Collaborate with the front desk, call center, and other departments as needed to resolve any billing/payor issues;
• Research, compile the necessary documentation, and complete appeal process for denied claims, via phone/email with payers, facilitating correct claims if necessary;
• Prepare, review, and transmit claims using billing software to include electronic and paper claim processing both primary claims and secondary claims;
• Follow up on unpaid claims within the standard billing cycle timeframe;
• Collaborate with the billing team when necessary to make coding changes to submit corrected claims or appeals;
• Stay current with payer trends as to how to submit corrected claims and the payer-specific appeal processes;
• Analyze root causes of denials; trends and issues: propose solutions and work with the management team to determine the appropriate action to resolve;
• Identify areas of concern regarding the various areas of the revenue cycle;
• Share trending and feedback to reduce denials to the CFO and/or Credentialing Coordinator;
• Hospital billing – identify charges that are billed for hospital visits, update spreadsheets and reports for documentation, and create claims to be billed;
• Apply insurance and patient payments to the Practice Management system, utilizing ERAs and manual application;
• Reconcile payments applied to the system to cash received;
• Answer patient's estimate of benefits or statements, telephone inquiries verifying insurance and benefits within the practice management system;
• Attend on-site/off-site community engagement activities, clinic events, and/or training as needed;
• Perform other duties as assigned to support HOPE Clinic's Mission, Vision, and Values.

Requirements:

QUALIFICATION REQUIREMENTS:

• 5-7 years of experience with revenue cycles, medical billing, collections, and payment posting;
• Understand regulatory and compliance requirements associated with submitting claims to payers;
• Experience with Electronic Medical Records (EMR);
• Strong communication and interpersonal skills;
• Expertise with medical and billing terminology;
• Excellent organization and time management skills;
• Proficiency in computers, particularly Word and Excel;
• Must be fully vaccinated against COVID-19 with the recommended dosage.

EDUCATION and/or EXPERIENCE:

• Bachelor's degree from four-year college or university (desired);
• Or 5-7 years related experience and/or training; or equivalent combination of education and experience;
• 1-2 years of supervisory experience;
• Knowledge of medical billing, front-office, physician practice management, and healthcare business processes;
• Strong understanding of medical billing/coding, with an understanding of various insurance carriers, including Medicare, private HMOs, and PPOs;
• Previous FQHC (Federally Qualified Health Center) RCM experience.

OTHER SKILLS and ABILITIES:

• Bilingual (Vietnamese, Chinese, Arabic, and/or Spanish with English) is preferred.
• Above average skills in language ability as well as public speaking and writing.
• Must have good transportation and a valid Texas Driver's license.