Revenue Cycle Manager

Job Description

Job Description

The Revenue Cycle Manager will work under the general supervision of the Chief Financial Officer. This position is responsible for ensuring that patient billing and processing of payment receipts are consistently completed timely and in accordance with policy.

The Revenue Cycle Manager will minimize bad debt, improve cash flow, and effectively manage accounts receivables. This position will coordinate effective management of revenue cycle activities across the organization to include, but not limited to front desk, billing, collections, financial counseling for patients, and staff training.

EDUCATION / EXPERIENCE :

• 7 plus years of Revenue Cycle Management (RCM) required.
• Medicaid and Commercial experience required.
• ABA industry experience preferred.
• Multi-site experience required.
• Build, document, and maintain RCM / Billing workflows.
• Must partner with the clinical team on coding & documentation requirements.
• Keeping up with and implementing CMS and payer coding and process updates.
• Track record of successful cash collections.
• Benchmark and minimize DSO, denials, rejections, and the Billing team's productivity.
• Manage Charge Master, Gross to Net, Write-offs, and refund policies, as well as other department policies and procedures.
• Self-starter, able to work with minimal to no supervision.
• Strong in SQL, Excel, and other MS Office programs such as VBA and / or other programming knowledge and experience

DUTIES PERFORMED :

• Supervise and evaluate assigned support staff in a timely manner. This position will supervise biller / coders, FSRs and PSRs.
• Ensure the accuracy of deposits, demographic, and other information entered into the patient billing system.
• Participate in program / service evaluation activities; facilitate changes in the provision of service based on Continuous Quality Improvement results.
• Compile and prepare various status reports for management in order to analyze trends and make recommendations.
• Participate in the preparation of the annual UDS report.
• Monitor data integrity for the practice management system. Report problems to the CFO or other appropriate personnel in a timely manner.
• Provide a monthly summary on the status of outstanding charges in the oldest column of the Accounts Receivable Aging report for all balances.
• Provide monthly report on the status of credit balances. (Unapplied Credit Analysis Report)
• Monitor gross charges to determine the potential need for an update to the fee schedule on at least an annual basis. Report findings and recommendations to CFO by October each year.
• Coordinate with the Practice Managers to stay current on credentialing issues, especially in the case of new providers, with an emphasis on scheduling mainly self pay patients for the new providers until they are credentialed with third party organizations.
• Monitor volume of charge and collection posting on a monthly basis to confirm that Billing Specialists are keeping up with patient encounter volume.

Recommend and / or implement changes to work schedule, as needed, when work flow in the Billing Department is significantly behind.

• Responsible for ensuring the timeliness of processing and correction of rejected claims.
• Maintain rosters of Managed Care patients for all plans which have been active within the two most recent calendar years.
• Maintain regular schedule for sending out billing statements in accordance with the Financial Policies and Procedures.
• Maintain and process for review of all billing statements which are returned to sender. Utilize public records and other resources to make best effort to obtain accurate billing addresses.
• Maintain a regular schedule for writing off bad debts, including a process which requires and documents attempts to collect or resubmit prior to removing the charge from outstanding receivables.

Submit Bad Debt Write Off Report to CFO.

• Monitor coding practices among providers to determine potential patterns of under coding or other irregularities.
• Keep Billing Specialists up to date on third party coverage contracts, assuring that current contractual terms are understood and applied correctly.
• Establish and maintain a regular process for follow up on patient accounts which are pending approval for third party coverage.
• Maintain current information for billing and collections processes for each third party carrier in a Billing Manual.
• Work with Practice Managers and Schedulers / call center to assure that patients are informed of requirements such as income and / or insurance verification at the time that the appointment is scheduled.

Confirm that patients who have coverage that is not accepted at our organization are made aware of this fact before appointment is scheduled.

• Assure that the need for any referrals and / or authorizations are addressed at the time of scheduling the appointment.
• Train PSRs / FSRs to identify uninsured patients who may qualify for Medicaid or other programs which can cover some or all charges.
• Maintain process for verifying insurance at the time of each billable patient encounter.
• Monitor and identify any patterns in remittance advices which would indicate the PSRs are not properly collecting insurance information.

In coordination with Practice Manager, initiate retraining and / or other corrective action indicated.

• Maintain a process of coverage verification for scheduled patients prior to appointment.
• Coordinate the Revenue Cycle Management team to address any deficiencies in staff performance uncovered by internal audits.
• Must hold all patient Protected Health Information (PHI) and other patient personal information and agency information in confidence, in accordance with the Employee Confidentiality Statement, which you have read, understand and signed.
• Actively participates in and complies with all aspects of the NHFHS Corporate Compliance Program, follow the Program Code of Conduct and obey all relevant laws, statutes, regulations and requirements applicable to Medicaid, Medicare and other State and Federal health care programs.
• Participate in CQI, other internal committees, special projects / observances or activities that promote improvements in organizational performance and / or advance the mission, goals and objectives of Family Health Centers.
• Adhere to schedules for work, lunch and breaks.
• Perform any other duties as assigned.

We offer competitive salary and Benefits (Health Insurance, Dental, Vision,401K)