Revenue Cycle Manager (In office required) en None

JOB SUMMARY     

Utilizing expertise in Revenue Cycle Management and leading strategic revenue management initiatives to achieve the requisite outcomes associated with improved patient, physician, and payer experiences. Provides leadership and recommendations to the Revenue Cycle team including registration, charge-entry, pricing, payer-provider enrollment, compliance, coding and service documentation, and all other aspects of front-end claims processing functions.

Job Classification: 219

FLSA: Exempt

Reports to: CFO

Location:  Albany GA , In Office

DUTIES AND RESPONSIBILITIES

• Revenue Cycle Oversight by managing front-end and back-end revenue cycle operations including registration, coding, billing, collections, and documentation 
• Lead operation assessment, development and implementation of operation systems and procedures to improve process cycle times and assure timely billing and collection of fees for services rendered.
• Develop and monitor compliance with policies and procedures for revenue cycle management. 
• Build productive relationships with staff, insurance providers and other vendors.
• Contract Negotiation Support includes collaborating with payors and providers to negotiate and maintain contracts aligned with organizational goals.  
• Assess and establish performance benchmarks. Communicate to teams on the performance standard and quality expectation to help achieve or exceed performance goals.
• Monitors KPI’s so that they may work closely with the individuals to improve service levels, cash flow, reduce denials, and minimize delinquent debt and 
• Provide strategic direction of claims processing and revenue assurance
• Manage staff and provide training, on-going education, and coaching/mentoring for department members.
• Continuously evaluate department efficiency, design and implement improvement strategies as needed to ensure revenue optimization
• Payor Analytics & Contract Modeling - Analyze contracted and government payor rates to support reimbursement modeling. 
• Develop models for fee-for-service, prospective payment system, risk-based, bundled payment, and value-based contracts.
• Ensure payments align with contracted fee schedules and address underpayments or denials
• Oversight of credentialing and enrollment
• Create strategic and related tactical plan, to ensure reimbursement and billing services are extraordinary
• Identify specific billing and reimbursement projects as they arise, allocate resources, ensure progress is tracked and meeting expectations and take corrective action, as required.
• Direct and oversee plans to ensure SOPs are in place for benefits investigations, appeals and billing operations and those SOPs are followed; Responsible for issue resolution by providing direction and recommendation for remediation.
• Helps to identify problems, offer solutions, and participate in their resolution. 

EDUCATION & TRAINING

• Bachelor's Degree required. Bachelors/master’s degree preferably in healthcare administration.
• In-depth knowledge of healthcare business practices, compliance, billing and collection operations (both insurance and institution), ICD 10 coding, CPT, analytics, third party clearing houses and analytics, practice management software, and AR management.

EXPERIENCE AND SKILLS

• Minimum 5 years of experience in Revenue Cycle Management.
• Minimum 3 years of experience is managerial role in RCM position.
• FQHC or community health center experience strongly preferred
• Experience with federal healthcare programs and compliance requirements
• Ability to multi-task, prioritize and work independently in a fast-paced, high-volume environment.
• Ability to communicate and work effectively with the leadership team, staff, physicians, and external customers
• Strong leadership skills and with strong sense of responsibility.