The Manager, Revenue Cycle is responsible for planning, organizing, and overall management of patient accounts, payments, appeals, denials and audits in an effort to maximize revenue. Ensures cash collections, days in accounts receivables, adherence to corporate compliance and adjustments are within established departmental goals. Develops, recommends, and administers company policies and procedures related to all revenue cycle functions. Establishes goals and priorities consistent with mission and goals of Pediatric Associates, as well as meets requirements for applicable federal, state and local regulatory and/or accrediting bodies.
ESSENTIAL DUTIES AND RESPONSIBILITIES
This list may not include all of the duties that may be assigned.
- Manages and resolves outstanding patient accounts as related to capitated agreements and Medicaid Fee-for-service (FFS).
- Oversee team’s productivity audits, tracks problematic trends, and compiles statistical data on a monthly basis.
- Identifies services, charges, and billing methodologies that detract from the maximization of revenue reimbursement and takes steps to correct and/or communicate to the VP of RCM.
- Collaborates with insurance companies to ensure payment, evaluate reimbursements, and make appeals when appropriate.
- Manages and ensures overall satisfactory level of cash collections and days outstanding in patient receivables.
- Researches and reconciles unapplied or misapplied payments and credit balances.
- Provides reimbursement, billing, and patient disposition guidance to staff.
- Implements corrective action to ensure the company’s favorable position regarding changes created by third party Payers.
- Represents the company to professional organizations and the community.
Supervises and manages a staff of revenue cycle employees include evaluating and completing annual performance evaluations. Holds monthly staff meetings, interviews and selects staff.
EDUCATION: Minimum High School diploma or equivalent required. Bachelor’s degree preferred.
EXPERIENCE: Minimum 3 years of supervisory or management experience in Revenue Cycle Management required. Medical or healthcare industry experience preferred.
KNOWLEDGE, SKILLS AND ABILITIES
- Knowledge of billing and collection policies and procedures, all types of insurance (HMO, PPO, POS, Medicaid etc.)
- Expert in capitated agreement and Medicaid FFS.
- Skill in defining problems, collection of data, interpreting billing information.
- Ability to communicate effectively and clearly.
- Familiar with Microsoft Office, E-Medsys, Zirmed, and Payer Websites.
- Ability to multi-task, communicate clearly both written and verbally
TYPICAL WORKING CONDITIONS
- Non-patient facing
- May rotate working in the office and remote/telework
- If remote, this job must be U.S. based
- Professional office environment
- Involves interaction with management and medical providers
- May require sitting for long periods
- Requires manual dexterity sufficient to operate a keyboard, type at 35 wpm, operate calculator, copier, and other office equipment
- Involves high and frequent call volumes
- Ability to perform data entry for extended period of time
- Occasional evening or weekend work may be required
OTHER PHYSICAL REQUIREMENTS
- Sense of sound
- Sense of touch
Develops and maintains appropriate communication and relationships with Front Office personnel and management in an efficient and effective manner. Creates a work environment to foster teamwork.
Maintains strict confidentiality in accordance with HIPPA regulations and Company policy.
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.