Revenue Cycle Manager

Revenue Cycle Manager

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 and responsibilities include managing overall medical billing operations, overseeing aggressive follow-ups with accounts receivables, tracking fee schedules and insurance denials, identifying and implementing strategies to improve internal and patient billing processes, incorporating and executing quality assurance processes related to ensuring accurate patient billing activities, reviewing and analyzing patient accounts, identifying trends and issues, and recommending solutions. Additionally, the Revenue Cycle Manager collaborates with other team members to improve / maintain an overall positive work environment for the team, provides a high level of customer service to both practices and patients by identifying and efficiently resolving insurance and other billing-related issues, collaborates with the front desk, call center, and other departments as needed to resolve any billing / payor issues, researches, compiles the necessary documentation, and completes appeal process for denied claims, prepares, reviews, and transmits claims using billing software to include electronic and paper claim processing both primary claims and secondary claims, follows up on unpaid claims within the standard billing cycle timeframe, collaborates with the billing team when necessary to make coding changes to submit corrected claims or appeals, stays current with payer trends as to how to submit corrected claims and the payer-specific appeal processes, analyzes root causes of denials; trends and issues : proposes solutions and works with the management team to determine the appropriate action to resolve, identifies areas of concern regarding the various areas of the revenue cycle, shares trending and feedback to reduce denials to the CFO and / or Credentialing Coordinator, hospital billing identifies charges that are billed for hospital visits, updates spreadsheets and reports for documentation, and creates claims to be billed, applies insurance and patient payments to the Practice Management system, utilizing ERAs and manual application, reconciles payments applied to the system to cash received, answers patient's estimate of benefits or statements, telephone inquiries verifying insurance and benefits within the practice management system, attends on-site / off-site community engagement activities, clinic events, and / or training as needed, performs other duties as assigned to support HOPE Clinic's Mission, Vision, and Values.

Qualification requirements include 5-7 years of experience with revenue cycles, medical billing, collections, and payment posting, understanding 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, and must be fully vaccinated against COVID-19 with the recommended dosage.

Education and / or experience include a Bachelor's degree from a 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 include bilingual (Vietnamese, Chinese, Arabic, and / or Spanish with English) is preferred, above average skills in language ability as well as public speaking and writing, and must have good transportation and a valid Texas Driver's license.