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Revenue Cycle Manager

1 month ago

Tigard, United States Insight Global Full time

Must Haves:

  • 3+ years’ of management experience with a focus on revenue cycle and Medicare/Medicaid billing (leadership experience must be recent)
  • Background in medical coding, either being a Medical Corder or working cross functionally with coding teams


Plusses:

  • Relevant certifications such as Certified Professional Coder (CPC), Certified Revenue Cycle Professional (CRCP), or Certified Medical Reimbursement Specialist (CMRS)
  • Experience with Epic electronic health record software
  • Non-profit, FQHC, or OCHIN experience


D2D:

Insight Global is looking for a Revenue Cycle Manager that will be responsible for fostering the department's development and expansion through various responsibilities. These include identifying organizational requirements, recruiting, training, and overseeing personnel. Additionally, they play a crucial role in advising the Executive Leadership Team on matters pertaining to the revenue cycle, contributing to strategi*decision-making. The manager's role is pivotal in driving continual enhancements to critical revenue cycle metrics and optimizing all facets of the billing process. Moreover, they are instrumental in formulating and executing strategies aimed at augmenting revenue streams within the organization.


Other duties will include but are not limited to:

  • Coordinate and support payer contracts by maintaining and updating payer contracts list; implementing contract requirements and troubleshooting revenue issues with provider representatives; reporting on utilization and comparing to practice management (PM) system; implement grant and value-based contracts, ensuring compliance and tracking via the PM system.
  • Develop, mentor, manage, and train revenue cycle staff, including timely feedback and annual reviews.
  • Coordinate with multiple departments and managers to ensure proper workflows, training, and follow-up for patient intake and revenue capture.
  • Collaborate with Epic and OCHIN on JIRA details related to revenue cycle activities.
  • Provide support and guidance on coding and documentation issues; feedback to providers on corrections; implementation of new services; managing coding audits and improvement projects; training and coordination with back office and billing staff to correct coding errors.
  • Create, implement, and monitor KPIs specific to the revenue cycle function to monitor performance and identify areas for improvement.
  • Prepares monthly wrap submissions, quarterly reconciliations, and appeals for PPS reimbursement from OHA.
  • Manage APM (Alternative Payment Models) patient enrollment and appeals.
  • Oversee the performance of OBS on the billing process, including claims processing, payment posting, denial management, AR follow-up, and patient collections.
  • Enrolls providers and facilities with clearinghouse. Oversees credentialing holds in PM system and troubleshoots credentialing denials.
  • Collaborate with finance staff projecting types of encounters and net visit revenue during the budget/forecasting process. Support finance staff with financial reporting by explaining encounters, net visit revenue, and trends/variances in accounts receivable.
  • Prepare and update the fee schedule for annual review by executive leadership.
  • Collaborate with the EPIC team to manage the fee schedule and preference lists, as well as create and test JIRAs to enhance charge capture and supplement EPIC clinical training.
  • Develop and update policies and procedures related to revenue cycle under the guidance of leadership.
  • Support FQHC and HRSA compliance within the organization including: the 340B program, VFC (Vaccines for Children), and others.
  • Perform other duties as assigned by leadership.