Revenue Cycle Manager at Universal Community Health Center

Description

The Revenue Cycle Manager (RCM Manager) oversees all functions in the Billing/Accounts Receivable department and is responsible and accountable for the revenue cycle process. This position works collaboratively with front-line staff, clinicians, department managers, and senior leadership to maximize revenue, provide reports demonstrating trends in patient accounts, and ensure accuracy and compliance in billing, collections, and denials. The RCM Manager also ensures proper oversight of related financial screening areas (e.g., sliding fee discount policy, patient refunds, patient collections, COVID-related claims, and write-offs).

Primary Responsibilities:

• Manage the day-to-day revenue cycle operational processes.  Our complete billing cycle in handled in house
• Participate in the development and implementation of organizational strategies, policies, and practices to create overall department success
• Identify reimbursement issues and take timely steps to resolve
• Set productivity goals, monitor, and eliminate barriers to achieving those goals at the individual and/or team level
• Manage billing department staff (5) in daily activities, assign work, set completion dates, review work and manage performance in accordance with established policies and procedures
• Analyze and assign new errors and denials
• Exhibits exceptional customer service skills; answering client calls; prompt return and follow up to all interactions;
• Prompt response to requests for information, both internally and externally initiates and maintains direct contact with CHMB clients, engaged in proactive resolution of issues and timely response to questions and concerns. 
• Clearly documents issues and resolution, as well as documents AR issues/status for client presentation. 
• Participates in client workgroups, if needed, to address AR issues. 
• Maintains a schedule of client meetings either monthly or quarterly depending on the size and scope of the client. 
• Professionally interacts with clients and patients to resolve questions and concerns. 
• Delivers timely required reports to the Director of Operations; initiates and communicates the resolution of issues, such as payer denial trends, collections accounts, inaccurate or incorrect charges, vendor input and implementation. 
• Identifies and provides timely resolution of process issues.
• Track clients’ AR productivity (charge, payments, collections, adjustments) on a daily, weekly and/or monthly basis; as needed to ensure the client and company expectations are met.
• Provide training and mentoring to staff; ensure standard operating procedures (SOP) are followed and improvements occur.
• Stay current with company’s policies and procedures regarding AR activity such as, reviewing month end reports to guarantee the AR is below 20% over 90 days, identifying trends.
• Analyze reports to determine when, how and why decrease in clients’ AR; includes denials, unbilled, credit issues; holds; communicate with client and staff to resolve.
• Review work performed by outside vendors for accuracy and production.
• Hires, retains mentors and manages staff to achieve organizational goals.
• Meets regularly with staff; in-person and as a group to confirm the status of client accounts, effectively prioritizing AR activities for staff holding them accountable for work performed. 
• Provides support, training and oversight to build and enhance a team to meet current and future business needs supporting our clients. 
• Analyze and address staff performance, conduct and other problems in a timely and professional manner, offering counseling, correction and discipline as appropriate. 
• Performs period reviews to mentor and give constructive feedback to improve performance. 
• Handle and manage internal staffing issues regarding daily matters, including but not limited to such items as timekeeping, coverage, workflow, and training. 
• Achieve goals set forth by supervisor, CHMB and compliance requirements.
• Other duties as assigned
• Assist in hiring and training new staff members
• Prepare reports for management and physician review
• Oversee and manage and direct the retrieval, approval and correction of claims as they come through the EHR to thePractice Management System.
• Reviews patient charges, payments and adjustments on automated systems.
• Reconcile charges, payments and adjustments posted to the system on a regular basis.
• Work closely with all stakeholders and billing personnel to assure the accuracy and integrity of the accounts receivable system, claims, registration processes.
• Report fiscal detail and trends to Executive leadership, regularly.
• Monthly review of patient statements, receivables.
• Ensure that all third-party denials are re-billed or appropriately adjusted.
• Help prepare yearly cost reports, UDS data, audit materials as requested.
• Work with Executive and Operations teams to ensure that any new programs and services are billable.
• Provide accurate detailed audit documentation for internal, external audits.
• Ensure processes are compliant with billing policies and procedures.
• Design and update business forms, as necessary.
• Train, supervise and evaluate revenue management, billing manager, billers, and coding staff.
• Facilitate patient and staff inquiries regarding financial accounts.
• Train and provide direction to other individuals whose functions directly impact patient financials, billing, denials, eg.Front Office and Medical Assistants.
• Provide over-site of outsourced accounts A/R management organizationsMaintain user access to external health plan, IPA portals used for membership reporting.

Essential Duties and Responsibilities:

• Review all visit’s data to ensure all services and diagnosis are accounted for.
• Develops reports/data to assist in the evaluation of business performance
• Develops best practice revenue cycle performance benchmark for Federally Qualified Health Center (FQHC)
• Participates in analysis of monthly/quarterly/annual consolidated financial data, including variance analysis and determination of profitability
• Assist with budgeting, and forecasting, including participation in business development and financing projects
• Prepare and assist in Medicare cost report and Medi-Cal reconciliation annual submission
• Review Sliding Fees and Fee Schedules to ensure up-to-date
• Handle ad-hoc reporting and analysis and investigate issues providing explanations and interpretations
• Review journal entries for revenues and allowance for doubtful accounts during month-end close
• Perform work in a self-directed manner and work with less structured, more complex issues
• Act as a resource to others Ad hoc projects
• Partner with internal and external stakeholders in key business areas related to Revenue Cycle management
• Work with management and other departments to improve billing workflow
• Analyze data from multiple sources, including patient accounting data, claims data, and clinical data from electronic medical records, to discover key insights for revenue cycle and operational improvement
• Review explanation of benefit forms received in the reimbursement process.
• Appeal any incorrect non/under-payments.
• Follow up on unresolved accounts receivables.
• Document procedures as needed.
• Provide required information on time and with a high degree of quality and transparency
• Ability to work independently and multi-task, with a strong attention to detail
• Ability to communicate effectively; excellent verbal and written communication skills
• Strong PC skills, including solid experience with standard Microsoft products
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
• Performs other duties as assigned by supervisory staff.
• Other duties as assigned by the supervisor.

Requirements

Job Qualifications:

• Education and/or Experience: Sufficient training and experience is required to demonstrate the ability to perform the above duties and responsibilities and to attain the knowledge, skills and abilities listed below.
• Required Education: Degree in Finance or Accounting or a related field
• Preferred Education: Bachelor in Finance, Accounting, Business, or Healthcare
• Required Experience: 5-7 years of experience in billing, revenue cycle management.
• Preferred Experience: previous experience working in FQHC environment

Competencies & Skills:

• Accountability: Takes ownership for delivering on commitments; owns mistakes and uses them as opportunities for learning and development; discusses openly his/her actions and their consequences both good and bad; has an ability to identify strengths and developmental opportunities and leverages insight in making adjustments adjusting to improve effectiveness; has the courage to engage in difficult conversation.
• Communicating Effectively: Sharing information. Listens and involves others. Clearly conveys ideas in a manner that engages others and helps them understand and retain the message.
• Decision Making/Judgment: Approaches problems and decisions methodically and objectively; involves others as needed; uses sound judgment in making decisions and understanding the impact to themselves, customers, their team, and the organization; conducts the appropriate analysis to identify the symptoms and root cause of issues; makes timely decisions.
• Results Orientation: Is focused on outcomes and accomplishments; follows through on commitments; can be counted upon to successfully execute on goals; motivated by achievement and a need for closure; has an attention to detail and is both efficient and effective in achieving a high level of measurable outcomes; persists in achieving goals despite obstacles.
• Oral Communication - Speaks clearly and persuasively; Listens and gets clarification when necessary; Responds informatively to questions.Ability to be approachable by staff
• Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives. 
• Professionalism - Approaches others in a polite and tactful manner; Maintains composure and reacts well under pressure; Treats others with respect and consideration; Accepts responsibility for own actions; Follows through on commitments. 
• Quality - Demonstrates accuracy and thoroughness; Applies feedback to improve performance; Monitors own work to ensure quality. 

Physical Requirement:

• Physical effort which may include occasional light lifting to a 25 pound limit, and some bending, stooping or squatting.  Considerable walking may be involved. The ability to sit or stand for extended periods of time is required.
• Flexibility to work in multiple locations throughout the week.  
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee may be required to travel to all UCHC facilities as needed.
• Occasionally required to sit and walk.
• Finger dexterity required.
• Hand coordination required.
• Specific vision abilities required for this job include: close vision, distance vision, ability to adjust or focus.

Work Environment:

• Exposure to adverse conditions.
• Exposure to extreme heat.
• Exposure to extreme cold.
• Exposure to wet and/or humid conditions.
• Exposure to moving mechanical parts.
• Exposure to high, precarious places.
• Exposure to fumes or airborne particles.
• Exposure to toxic or caustic chemicals.
• Exposure to outside weather conditions.
• Possible risk of electrical shock
• Exposure to explosives
• Possible risk of radiation and vibration.
• Protective clothing or equipment is required including: gloves, helmets, steel-toed boots, protective eyewear.
• The noise level in the work environment usually is high

Equal Employment Opportunity

Universal Community Health Center is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), age, disability, genetic information, national origin, or any other protected characteristic as defined under applicable state, federal, or local laws.