Revenue Cycle Ar Manager

POSITION TITLE:Revenue Cycle Manager

DEPARTMENT: Finance

FLSA STATUS: Exempt

REPORTS TO: VP, Revenue Cycle

DATE PREPARED: April 2024

SUMMARY OF JOB DUTIES:

The Revenue Cycle Manager manages, coordinates, and oversees overall daily billing operations of Complete Health physician practices to ensure maximization of cashflow while improving patient, physician, stakeholder and other customer relations. Responsibilities include; stewardship of Patient Billing and Collection, A/R Management, Application Systems Support, Claims Management, Coding, Charge Capture, Data Entry, Account Follow-Up, Customer Service, Denial Management, Edit Management, Payment Variance Analysis, Contract Analysis, Credit Analysis, Refund Management, Payment Posting, Auditing, Training, and Productivity and Performance Reports.

The Manager provides oversight and support for Group Practice Revenue Cycle integrity and workflow processes. Assures all established billing systems, and workflow process requirements have been met in order to ensure timely and optimal reimbursement. Manages the development of regular business operations reports and works to improve Revenue Cycle production and efficiency through the analysis of key performance indicator data. The Manager recommends changes that will positively impact the Revenue Cycle and help the Central Business Office operate according to industry benchmarks and meet A/R performance goals and productivity.

ESSENTIAL JOB FUNCTIONS:

• Manages the operational performance and overall management of the Central Business Office (CBO) by performing all necessary functions to support Revenue Cycle goals and align to industry benchmarks.
• Ensures activities of CBO billing operations are conducted in a manner that is consistent with overall department billing protocols, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements. Implements and monitors adherence to the organization's billing, collection, and refund policies and procedures.
• Reviews, and assesses Revenue Cycle activities and functions by interpreting operational data to assess need for procedural revisions and enhancements; participates in the design and implementation of specific systems to enhance revenue and operating efficiency.
• Participates in monthly Department Administrator and Operations meetings, Revenue Cycle meetings, as appropriate to provide data and feedback on Revenue Cycle operations management. Prepares regular and ad-hoc reports and presentations to support meeting agendas.
• Promotes effective communications between Central Business Office personnel, Front-End staff, and Department Administrators to ensure ongoing education/training and expedite problem resolution.
• Supports company, group, and department financial analysis. Provides feedback and works directly with Clinic sites with support from practice managers and Market Directors to develop and implement action plans for improving operations and business-related functions impacting billing and reimbursement needed to identify and manage challenging Revenue Cycle processes and problem payors.
• Assists and participates in creation of training manuals and job aids for respective area(s) of expertise and responsibility.
• Conducts change readiness assessments, evaluates results and presents findings in a logical and easy-to-understand format.
• Participates in new service/business line research and assessment and provides business and analytical support for the reporting and research of existing and potential opportunities for revenue enhancement.
• In conjunction with the Revenue Cycle Director and Supports Complete Health's growth efforts, clinical initiatives, and development of new markets by assuring provider and system setups and tablespace expectations are delivered timely.

MINIMUM REQUIREMENTS

• Bachelor's degree preferred.
• Certified Professional Coding Certificate from AAPC o
• At least 5 years of experience in healthcare Revenue Cycle required.
• Knowledge related to accounts receivables, billing systems performance, coding, A/R reporting, and revenue management analysis.
• 2-3 years Management experience in Practice Management or Revenue Cycle Management Preferred.
• Experience with physician billing in primary care setting preferred.
• Advanced knowledge of third-party insurance, and familiarity with insurance plan types; HMO, PPO, POS, and Indemnity.
• Excellent knowledge and understanding of EHRs and Physician Billing Systems. Athena experience preferred.
• Excellent knowledge of the Commercial, Medicare, HMO, and PPO Programs particularly as it relates to CPT procedures and ICD-10 diagnostic coding and billing. Thorough knowledge of Medicare Fraud and Abuse regulations.
• Ability to counsel patients financially regarding outstanding charges and effectively resolve problems exhibiting the highest customer service skills and etiquette.
• Excellent knowledge of HIPAA regulations.