Manager of Revenue Cycle

Overview:
The Revenue Cycle Manager is responsible for the day-to-day supervision, direction and leadership for a team of associates, directing the accurate, timely and completion of assigned revenue cycle tasks. Executes policies and procedures for insurance verification, authorization, billing, collection and reimbursement processes in accordance with legal requirements and in support of company fiscal policies. Manages all aspects of the accounts receivables and communicates results to agencies. Oversees function and ongoing operation of electronic systems involved in the patient accounting process. Directs an assigned group of supervisors, coordinators and team leads in charge of day-to-day operations, Supporting assigned agencies, operational, human resources, and service excellence policies and procedures. This position assumes overall responsibility for clearly assigning tasks and communicating decisions, setting clear objectives and measures, and for monitoring and reporting on process, progress, and results.

Responsibilities:
1. Supports CommonSpirit Health at Home’s mission, values, strategic goals and high standards of customer service. Consistently lives People First behaviors.
2. Adheres to the Corporate Compliance Program, including confidentiality HIPAA protected health information.
3. Follows the policies and procedures of the organization.
4. Demonstrates a personal commitment to professional and supervisory competence and growth.
5. All other duties as assigned.

 

Revenue Cycle Management:
1. Develops, leads and maintains policies, procedures and best practice within company guidelines for assigned revenue cycle operations; insurance verification, authorization, billing, collection and reimbursement functions.
2. Directs and manages the timely and accurate maintenance and reconciliation of billing, cash and accounts receivable processes.
3. Directs the timely and accurate maintenance and reconciliation of reimbursement issues.
4. Maintains files and reports related items to billing and reimbursement as required by law.
5. Analyzes and provides financial trend reports in areas of adjustment reasons, denial reasons, resubmitted billings, accounts receivable, held revenue, late or retro charges, etc.
6. Communicates state, federal, local government program regulations, topics of fraud and abuse, etc. relating to company reimbursement.
7. Collaborates with Operations, IT, Revenue Cycle Support and Accounting to when necessary.
8. Provides support and works in collaboration to the assigned agencies to receive expected reimbursement using different tools:
a. Open communication
b. Account Receivable Meetings
c. Key Performance Indicators
9. Researches and assists in training issues.

10. Promotes and reaches consensus with other directors and managers regarding company objectives.
11. Reports major account/payor problems affecting DSO goal attainment.
12. Employs and assigns qualified personnel to implement the day-to-day operations of assigned teams.
13. Works with Revenue Cycle directors, managers and supervisors to ensure adequate staffing levels are anticipated and maintained.
14. Directs individual subordinates and groups to appropriate resources to resolve problems.
15. Provides guidance to managerial personnel in the hiring of subordinates.
16. Functions as a role model and assists with driving achievement of organizational goals and objectives by encouraging and facilitating improvement initiatives and cooperation among associates.
17. Manages performance as appropriate by creating an “expectation of excellence”.
a. Sets performance goals and monitors results
b. Establishes/manages productivity system for staff and ensures the organization maximizes the contributory value of associates.
c. Creates opportunities for continuous improvement of staff performance, development, and morale through fair and accurate performance evaluations on time per organizational policy, daily coaching and mentoring to increase organizational performance. Accurately differentiates levels of performance for rewards. Actively addresses insufficient performance by taking appropriate corrective action as needed.

18. Creates a strategically focused participative and engaging team environment. Provides motivation and retention of a qualified staff, assuring the quality and timeliness of completed work thereby aiding organizational financial success.
19. Responsible for aid in the retention of qualified staff to meet or exceed the turnover goal. Provides fair and equitable treatment of all associates.
20. Creates a work environment which is characterized by mutual trust and respect. Develops associates to support their personal career goals and a sense of belonging, and adequate recognition of accomplishments.
21. Maintains payroll records for associates in a timely, accurate and consistent fashion.

22. Assures all financial intake and billing tasks are completed timely and accurately.
23. Monitors workflow to ensure requests are submitted within time limits and followed up when necessary.
24. Maintains knowledge of contractual and regulatory requirements for individual payors.
25. Develops and monitors individual and team performance and quality measures.
26. Maintains knowledge and stays abreast of reimbursement requirements for all payors. Keeps staff informed of any payment, authorization, coding, denial or submission criteria on assigned payors.
27. Keeps the Senior Director informed of any developments within their area of responsibility which may require action or be pertinent to the performance of their duties: Provides Managers with issues and potential resolutions regarding problems in their respective area of responsibility.
28. Cooperates with other revenue cycle leadership to develop best practice processes.

Team Leadership:
1. Provides guidance & continued education to associates to ensure appropriate processes are followed.
2. Provides pertinent feedback to management for annual and ongoing staff assessments.
3. Identifies trends and workflow issues that need additional coaching or staff mentoring.
4. Assists management with assessing training and development needs and conducts training for assigned staff to meet required competencies and provides opportunities for growth.
5. Functions as a role model and assists with driving achievement of organizational goals and objectives by encouraging and facilitating improvement initiatives and cooperation among associates.
6. Maintains a high level of staff morale as evidenced by team spirit, a sense of belonging, and adequate recognition of accomplishments.
7. Ability to solve problems and resolve conflicts.
8. Prioritize tasks and set goals.

Qualifications:
1. Bachelor's degree in business related field or equivalent education and/or experience required.
2. Seven years of relevant experience in a healthcare revenue cycle setting with a minimum of 5 years in management or leadership role in a health care setting.
3. Knowledge of Generally Accepted Accounting Principles (GAAP), home health care, hospice, pharmacy payor sources, accounts receivable, cash management, billing, rules and regulations governing third party payors
4. Leadership skills. Demonstrated ability to effectively manage and lead associates and teams.
5. Strong customer service skills.
6. Must be able to interface well with all levels of management.
7. Ability to work effectively and collaboratively as a member of interactive teams.
8. Experience with selection and implementation of healthcare computer systems. Experience with the management of computerized billing systems.

9. Excellent communication skills, both oral and written, in order to communicate effectively with patients, co-workers, insurance companies and others.
10. Proven organizational, analytical and critical thinking skills.
11. Strong computer skills, especially Microsoft Office Suite and Google products.
12. Strong understanding of revenue cycle processes including third party payor requirements, as well as working knowledge of government, legal, third party contractual and regulatory provisions related to revenue cycle activity.
13. Reliable, responsible, goal-oriented and flexible; demonstrates a vested interest in self-development.
14. Ability to work autonomously in relation to day-to-day operations and decision making.

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