Revenue Cycle Management Manager

The RCM Manager will oversee the daily operations of the revenue cycle management department, focusing on claims processing, denial management, collections, and payment posting. This role ensures efficient RCM workflows, maximizes revenue capture, and drives continuous improvement in key performance metrics, including clean claim rates, AR aging, and denial resolution. The ideal candidate will possess a strong understanding of industry standards in revenue cycle management, demonstrate exceptional analytical skills, and lead the team to meet and exceed client service expectations. This role will work EST time schedule.

Key Responsibilities:

Revenue Cycle Operations Oversight

• Lead end-to-end revenue cycle functions, including claims submission, charge capture, billing, payment posting, denial management, and collections, ensuring accuracy and compliance with industry regulations.
• Establish and maintain efficient workflows for each step of the revenue cycle, prioritizing high-quality service and prompt resolution of claims to minimize AR aging.
• Monitor revenue cycle metrics and KPIs, such as clean claim rate, denial rate, and AR days, ensuring optimal financial performance and adherence to client service standards.

Denial Management and Claims Resolution

• Oversee the claims denial management process, developing strategies to prevent denials, reduce denial rates, and improve overturn rates on appealed claims.
• Collaborate with coding, billing, and follow-up teams to identify patterns in denials and implement corrective actions to reduce recurring issues.
• Ensure timely and accurate claims resolution, working with insurance companies and clients as necessary to address and resolve complex claims.

Team Leadership and Development

• Lead, coach, and develop the RCM team, providing training and mentorship to improve team performance and ensure alignment with department goals.
• Set team goals and objectives aligned with organizational targets, regularly reviewing team progress and providing constructive feedback.
• Foster a collaborative team culture focused on client satisfaction, efficiency, and professional growth, with opportunities for skill enhancement in RCM processes and client relationship management.

Client and Stakeholder Communication

• Serve as the primary point of contact for clients regarding revenue cycle performance, addressing client inquiries, providing status updates, and delivering data-driven insights.
• Conduct regular client meetings to review RCM performance, address concerns, and provide recommendations for improving collections, payment posting, and AR management.
• Collaborate with other departments, such as coding and compliance, to ensure cohesive and effective revenue cycle operations.

Process Improvement and Compliance

• Continuously analyze and optimize revenue cycle workflows to improve efficiency, reduce AR aging, and increase revenue capture, utilizing data and feedback from clients and staff.
• Ensure compliance with federal, state, and industry regulations governing claims processing, billing, and collections, maintaining a high standard of data security and patient confidentiality.
• Stay informed about industry trends and best practices, implementing relevant changes to enhance the organization's RCM services.

Qualifications:

• Experience: 5+ years of experience in revenue cycle management, with at least 2 years in a management or supervisory role. Extensive knowledge of claims processing, denial management, and AR follow-up is essential.
• Excellent interpersonal and communication skills.
• Ability to build and maintain strong client relationships.

What your impact will be:

• Provide industry, regulatory, and billing/collection compliance guidance to the team.
• Provide coaching and development to the team
• Act as an agent of change within the business unit and with customers
• Ensure quarterly meetings are conducted with clients' executives to review service level expectations and business overview.
• Responsible for managing staff to ensure a high level of customer satisfaction is maintained
• Identifying, improving, and standardizing processes for service delivery
• Ensure that established control procedures are in place and identify control risks
• Will have P&L / OPEX responsibility for the RCM and PS team
• Financial responsibility for the group including forecasting alongside leadership.
• Set, meet and monitor departmental goals to drive optimal performance.
• Regular process review to improve efficiencies wherever possible
• Travel on occasion, primarily Customer Service Visits, User Group Meetings and/or Conferences.
• Actively manage personnel issues including, but not limited to, hiring, preparation and delivery of mid-year and year-end staff performance evaluations, development of employee performance action plans, administration of corrective action and termination of underperforming staff, if necessary