Revenue Cycle Manager
This position oversees all aspects of the billing process, including billing, coding and compliance, reimbursement, and accounts receivable. The person is responsible for the accurate and timely completion of the entire revenue cycle process through setting and enforcing policies and procedures, maintaining current knowledge of changes in compliance standards and payer policies, analyzing data for reimbursement trends, and interfacing with internal and external leaders to resolve identified issues. The manager will be expected to understand and manage the denial processes, monitor, track, and evaluates staff productivity and performance and provide summary reports for executive management on a monthly basis. The person in this position must be able to multi-task and function in a fast-paced environment.
Manages daily tasks and assignments for Billing and Collections Staff
Manages the electronic and paper claim submission process.
- Manages the electronic and paper claim submission process.
- Ensures all data elements are loaded in the billing system and updated as needed.
- Ensures that claims are submitted timely for processing by payers.
- Ensures and reviews all edits and payer related items are accurate and up to date.
- Manages billing error reports to ensure proper claims are being submitted to payers.
- Manages projects for all insurance plans for payment of services.
- Manages patient collections, reimbursement and provider enrollment issues regarding payment of claims.
- Addresses escalated patient calls and ensures situations are resolved in a tactful and professional manner.
- Is able to perform the tasks of a Billing & Collection Staff when necessary.
Staff management for Billing Department
- Manages employee performance through coaching, appraising and motivating.
- Sets staff performance goals and productivity to ensure payments are collected timely.
- Continually reviews tasks for process improvement and increased reimbursement.
- Reviews productivity performance with staff quarterly and addresses issues with the individual staff in a timely manner.
- Develops quality assurance criteria for activities in area of assignment and performs regular audits and review and findings with staff.
- Interviews and hires billing staff for replacement or expansion.
- Maintains high professionalism and promote an environment of open communication and collaboration with billing staff.
Interaction with other Departments
- Works closely with Directors, Managers and Supervisors to ensure front office personnel collects and inputs all relevant patient and third party insurance information into Electronic Medical Record.
- Ensures new programs are provided with training and leadership for successful registration, billing and collection procedures.
- Monitors encounter slips to verify that all components needed are present to ensure submission of clean claims. Addresses related issues directly with clinical Providers when the required information is missing.
- Works with management to establish revenue cycle benchmarks and improve operations.
- Works closely with the credentialing contractor to ensure compliance with Third Party Payer requirements.
- Establishes, updates and maintains policies and procedures governing the billing system and ensures that they are all current, complete and user friendly at all times.
- Prepares reports and conducts analysis for management. Recommends actions and ensures accounts are addressed timely.
- Gathers appropriate departmental statistics for reports that reflect monthly/annual operating position.
- Conducts results analysis in sufficient time to allow for appropriate action to be taken.
- Uses experience, education or training and judgment to plan and accomplish key performance indicators for A/R days, A/R aging as well as other A/R metrics which play a major role for the organization to continue to grow.
- Serves as a liaison to software vendors.
- Utilizes existing reporting tools including Microsoft Office Applications/ Excel to extract data for management and for troubleshooting.
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
- Maintains a high degree of confidentiality pertaining to Mazzoni Center and patient care that adheres to HIPAA compliance policies.
- Performs special assignments, duties and related functions as required or assigned.
- Three to five years of progressive management experience required.
- Five years of related physician business office billing and collections management experience required.
Education, Training, License and Certification, Skills
- Bachelor's degree obtained through a formal 4-year program required.
- Must be cross-trained in electronic medical records, scheduling software and Microsoft Office.
- Certified coder preferred but not required.