Senior Revenue Cycle Manager

POSITION SUMMARY:

The Senior Revenue Cycle Manager is accountable for leading and managing the revenue cycle operations within the Company by providing quality billing and collections services, as well as accurate, timely, and efficient billing, collections, and administrative processes. He/she will be responsible for strategic planning, goal setting, monitoring/measuring work performance, fiscal/budgetary management, operations/workflow management, human resource management, project management, risk management, continuous quality improvement, information management, ongoing communication, and customer service within the revenue cycle operations. He/she will also be responsible for insurance eligibility processes, charge processing, claims submission, and processing, payment posting, collections, and accounts receivable, denial management, reporting results and analysis, concurrent and retrospective auditing, proper coding, credentialing, insurance contract review and oversight, customer services relative to revenue cycle, training and development related to revenue cycle, analytics of key performance indicators, and all other revenue cycle management activities.

JOB ESSENTIAL DUTIES:

· Responsible for leading, managing, coaching, and guiding all associates assigned to the department and maintaining positive, effective communication with providers, supervisors, peers, and subordinates

· Collaborates with healthcare providers in assessing, planning, implementing, and evaluating the needs of the patients and the organization. Develops solid, strategic business plans and department SMART goals

· Responsible for measuring, monitoring, and meeting key performance indicators and departmental goals by the company’s established policies and procedures and industry best practices

· Administers fiscal operations for the revenue cycle department, including financial planning, budget development, approving expenditures, meeting, or exceeding financial projections, reviewing financial reporting, and explaining variances

· Manages revenue cycle-related functions of the office/hospital visit from the point of charge entry to full adjudication of the patient’s account. Ensuring timely submission of claims, payment posting, denial management, and statements

· Responsible for maximizing the collection of payments and reimbursement from patients, insurance carriers, government agencies, and guarantors

· Monitors aged accounts and verifies appropriate collections procedures are being followed.

· Identifies, analyzes, and addresses challenges and/or breakdowns in the revenue cycle processes

· Plans, implements and administers programs and services, including personnel administration, training, regulatory compliance, and best practice workflow process.

· Develops and implements billing practices by leveraging technology to automate and standardize processes

· Responsible for ensuring proper training is conducted, including Orientation, skills/competency training, new equipment/process training, continuing education, standard operating procedures, policies, and documentation within the electronic practice management system

· Rounds frequently to observe, review, and analyze revenue cycle operations and workflow activities to ensure best practices are in place and being utilized

· Meets regularly with subordinate staff to identify and resolve issues and promote good communication and dissemination of information

· Manages and actively recruits, hires, trains, and retains top talent within the revenue cycle department

· Establishes work schedules and assignments for staff, according to business needs, space, and equipment availability

· Validates time sheets, and authorized vacation time, and is responsible for providing adequate coverage for all revenue cycle functions

· Assists with an annual review of departmental policies, job descriptions, staff plans, and departmental budget

· Participates in interdepartmental operations meetings as assigned

· Regularly provides department leadership and revenue cycle staff with revenue cycle status including reports, key performance indicator metrics, and presentations

· Resolves escalated reimbursement issues with payers, providers, and systems for optimal management of account receivables

· Stays abreast of Medicare/Medicaid and third-party payer billing guidelines and communicates these changes to all interest parties

· Helps with internal and external auditing processes

· Assists in the design of superbills, updating of codes, and charges in the EPM system.

· Supports the goals and mission of MCR Health Services

· Adheres to all safety policies and procedures

· Maintains a clean, clutter-free, and well-organized workspace

· Participates in community functions as appropriate and promotes the concept of “Patient’s First”

· Performs and embraces all other duties as assigned

SKILLS, KNOWLEDGE & ABILITIES:

· Ability to influence and motivate staff positively, proactively, and transparently by fostering teamwork and executing sound policies and procedures. Leading by example

· Takes ownership and accountability for individual and department performance. Continually guiding individuals and teams in achieving and exceeding goals and initiatives

· Possess exceptional customer service skills with the ability to relate to the public and patients, regardless of ethnic, religious, and economic status.

· Possess exceptional independent, critical thinking skills with the ability to identify issues, collect and analyze data, establish facts, draw valid conclusions, make recommendations, and implement effective action plans to solve problems.

· Possess exceptional communication, interpersonal, and organizational skills with the ability to build strong relationships and effectively influence diverse groups at all levels within the organization.

· Excellent written, oral, and active listening skills

· Strong time management skills with the ability to properly prioritize, manage, and complete simultaneous tasks with frequent interruptions while paying close attention to the details

· Ability to work in a fast-paced environment with a variety of personalities and work styles

· Possess a high degree of empathy, ethics, initiative, and judgment with the ability to maintain confidence relating to sensitive matters

· Ability to work well under pressure with tight deadlines and with a sense of urgency

· Ability to be flexible in schedule and adaptable to constant change

• Bachelor’s degree in healthcare administration, Business Administration, Finance, Accounting, Revenue Cycle Management, or work-related field required.
• 5–7 years of progressive healthcare revenue cycle experience, with demonstrated leadership responsibility.
• Experience managing multiple revenue cycle functions in healthcare, physician practice, ambulatory care, hospital, or similar environment.
• Strong knowledge of healthcare billing, claims processing, accounts receivable, denials management, payment posting, and reimbursement processes.
• Demonstrated experience improving revenue cycle performance and reducing A/R and denials.
• Experience with electronic health records (EHR), practice management, billing, and revenue cycle management systems.
• Strong analytical, financial, organizational, and problem-solving skills
• Excellent written, verbal, interpersonal, and presentation skills.

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