Revenue Cycle Manager

Location: (FL)

The Revenue Cycle Manager reports to the CFO and is responsible for overseeing and coordinating all Revenue Cycle activities with a goal of maximizing reimbursement in a cost-effective manner that is in compliance with federal, state and payer-specific billing requirements.

Responsibilities:

• Develop and implement Revenue Cycle policies and procedures to ensure efficient and effective operations.
• Oversee and support the daily operations of across all Revenue Cycle functions:
  • Patient Pre-Service RCM:
    • Monitor patient scheduling and oversee advanced scrubbing of patient scheduling.
    • Ensure eligibility checks are completed and strong communication in-place to support on-site team with questions about walk-up patient coverage.
    • Ensure compliance with referrals and authorizations.
  • Patient Point of Service RCM:
    • Possess strong knowledge of check-in and patient registration process from an operational perspective.
    • Develop processes and reporting to ensure Co-Pay, Past Due Balances are collected at time of service.
    • Ensure on-site staff are educated and maintain compliance with patient self-pay process.
    • Ensures compliance with relevant federal, state, and payor-specific billing requirements.
    • Review and provide oversight of Coding & Charge entry. Work with Providers and other medical staff to promote an environment of continuous learning to maximize collection of medical services.
  • Patient Post Service RCM:
    • Develop and maintain claim scrubbing & edits.
    • Oversee daily and timely filing of claim submissions.
    • Work to resolve any payor, credentialling, EDI issues related to claim submissions.
  • Billing & Collections RCM:
    • Ensure Daily posting of payments (ERA & Paper)
    • Maintain clinic’s fee schedules and monitor/report variances to management and payors.
    • Oversee denial management and resolve any issues.
    • Follow-up with payors / insurances as needed on AR related issues.
    • Oversee Primary and secondary insurance billings.
    • Ensure timely (weekly) patient statement delivery and collections.
    • Maintain adherence to insurance and patient overpayment and refunds process.
    • Respond personally to concerns and/or complaints expressed by patients, visitors, staff, and physicians in effort to support optimal operations and excellent customer service.
• Leadership
  • Direct the selection, supervision, and evaluation of staff. Ensure performance and coaching for excellence ensuring high performance across the Revenue Cycle.
  • Oversee orientation and continuing education for all cross-functional staff that influences the Revenue Cycle.

Qualifications:

• This position requires a bachelor’s degree in business or related field is required.
• Minimum five years of mid-level experience in physician enterprise or medical group Revenue Cycle management.
• Strong understanding of medical billing, coding, and reimbursement processes.
• Proven track record of improving Revenue Cycle performance and reducing accounts receivable.
• Excellent leadership, communication, and interpersonal skills.
• Ability to analyze data and make data-driven decisions.
• Strong problem-solving and critical thinking skills.
• Knowledge of relevant federal, state, and local regulations related to billing and collections.
• Ability to work and communicate effectively with a diverse group of people including other department managers, staff, physicians, patients, and the public.
• Outstanding ability to work independently to achieve results. Often, there is no precedent for and little help in carrying out assigned tasks. Must originate, plan, adapt and invent to accomplish tasks.
• Ability to set and maintain priorities when dealing with multiple demands and interruptions.
• Proficiency in Microsoft Office Suite and Revenue Cycle management software.
• Experience working with Modernizing Medicine (EMA). -Preferred