Revenue Cycle Manager - ICC

HealthRIGHT 360 gives hope, builds health, and changes lives for people in need by providing comprehensive, integrated, compassionate care that includes primary medical care, mental health services, and substance use disorder treatment.

The Integrated Care Center Clinic is a federally qualified health centers that provide primary care, behavioral health, addiction treatment, psychiatry, dental care, and more. We provide care to those most in need including those who are suffering from homelessness, mental illness, substance use, mental illness, and chronic medical conditions. We provide team based care in an integrated care setting. We are looking for a mission driven, service leader who works well in a team, has experience with managing and supporting staff, champions quality improvement, leads change, and is excited to innovate.

Benefits and perks:

• HR360 offers a robust benefits package, including PTO, 15 paid holidays, commuter benefits, retirement plans, and more!
• Employees qualify for public loan forgiveness programs
• Training and professional development opportunities
• Work with mission driven, compassionate colleagues and make a difference every day in the work that you do.

JOB SUMMARY

HealthRIGHT 360, a nonprofit organization and a family of programs, is committed to providing accessible and comprehensive healthcare services to vulnerable populations. Our mission is to tackle systemic barriers to healthcare and promote health equity for all. We offer a wide range of services, including mental health care, residential and outpatient substance use treatment, and primary health services. Additionally, we provide transitional support for individuals re-entering the community after involvement in the criminal justice system. By integrating physical and behavioral health, we empower individuals to overcome challenges by addressing social determinants of health, fostering resilience, and facilitating recovery.

The Revenue Cycle Manager is responsible for managing HealthRIGHT360's clinical database/billing system, including e-Clinical works (ECW), reconciling insurance claims, and tracking UDC's/UOS for HealthRIGHT 360's medical contracts. This role will manage the revenue cycle for a fast paced, deadline driven Community Health Center. The Revenue Cycle Manager will directly supervise the Billing staff, while holding them accountable to achieve positive financial outcomes. The position requires active engagement in cross departmental teams, strong problem solving and research skills. The Revenue Cycle Manager will be expected to educate leadership, administrative, clinical and billing staff on the full picture related to the reimbursement cycle for Medi-Cal, Medicare, FPACT and other payers.

KEY RESPONSIBILITIES

Leadership & Staff Management

• Oversee Billing staff including work allocation, review of work to ensure accuracy and compliance, training, and problem resolution.
• Interview, hire, orient, and train new billing staff.
• Perform annual performance evaluations, set goals, and monitor progress.
• Train staff in new billing policies and procedures and reinforce existing policies.
• Assure adequate coverage during staff absences to guarantee minimal disruption of billing services activities.
• Demonstrate a leadership style that promotes enthusiasm and dedication to the facility and its administration.
• Notify PMG of all termed/hired employees.

Billing Operations & Revenue Cycle Management

• Monitor timely and accurate registration, billing, coding, and follow-up through reporting metrics and analytical tools.
• Monitor and report on all billing operations including collections, charge capture, contractual adjustments, account volumes, productivity, turnaround time, denial analysis, coding/documentation quality, and payment accuracy.
• Execute routine reconciliation processes of payment posting, bank statements, front desk cash logs, and deposits.
• Review denial, rejection, and paid claim data; develop corrective action plans for staff and providers to maximize accuracy in coding and reimbursement.
• Daily resolution of electronic billing errors and follow-up on transmissions to ensure correct submission.
• Resubmit claims/batches when required.
• Review Aged and Summary billed reports to ensure appropriate follow-up of outstanding balances.
• Maintain and ensure proper coding for encounters, including updates of ICD-10 and CPT codes.
• Develop and manage the electronic billing system by inactivating/adding CPT & ICD-10 codes, updating Federal Poverty Level, Sliding Scale Fees, and charges annually.
• Manage client accounts and hardship applications.

Policy, Compliance & Documentation

• Maintain and update the Clinic's billing policies and procedures manual; distribute billing updates to the team.
• Follow HIPAA guidelines and maintain confidentiality of patient, provider, and employee records.
• Ensure compliance with billing requirements (Medi-Cal, Medicare, HRSA, and other regulations).
• Participate in audits, including preparation and review of requested schedules, reports, and documentation.
• Provide training and guidance on compliance-related issues.

Credentialing & Payer Relations

• Provide support and assistance to the credentialing liaison regarding provider enrollment, site certification, and billing issues.
• Obtain provider materials needed for credentialing with all payer sources.
• Responsible for payer set up/maintenance, new service set up, CPT code set up, charge master maintenance, and related problem-solving.
• Keep current with HealthRIGHT 360's Medical Program funding sources, including Medi-Cal, Medicare, Family PACT, Managed Care, and Commercial Insurances.
• Work with PMG on outstanding AR.

Analysis, Reporting & Strategic Initiatives

• Assess effectiveness of the revenue cycle and recommend improvements through workflow analysis, documentation, dashboards, reports, queries, and other tools.
• Interpret and convey complex clinical/financial information clearly; prepare informative reports and presentations for all levels of staff and management.
• Monitor and analyze denial and claim trends, identifying and implementing solutions.
• Work closely with Operations, IT, Health Plan Services, Credentialing, Health Insurance Enrollment, and VP of Healthcare Services to identify EHR-related workflow issues and resolve them.
• Advise VP of Healthcare Operations and management on revenue cycle developments, improvements, regulatory changes, and industry trends.
• Provide program leadership for large strategic and cross-functional workflow initiatives (defining scope, engaging stakeholders, managing timelines and deliverables).

Collaboration & Team Engagement

• Work on highly complex projects in a team environment, actively engaging with clinical and financial team members.
• Participate in Coordinating Team and Large Management meetings, offering suggestions related to operational improvement, scheduling, coding, HIPAA, and compliance issues.
• Work closely with management to ensure daily charge reconciliation is completed.

And, other duties as assigned.

QUALIFICATIONS:

Education, Certification, and Experience

• Associates Degree in related field.
• Certificate in Medical Terminology or Billing and Coding.
• 2+ years of experience in accounting or billing department.
• Ten key experience.
• Data entry experience.
• Experience using billing software; eCW and ClaimRemedi, esolutions preferred.
• Bachelor's degree in accounting or related field.

Knowledge, Skills and Abilities

• Excellent command of spreadsheet applications.
• Culturally competent and able to work with a diverse population.
• Strong proficiency with Microsoft Office applications, specifically Word, Excel, Outlook and internet applications.
• Strong verbal communication.
• Proficient in Excel.
• Strong attention to detail.
• Excellent time management skills.
• Ability to enter data into various electronic systems while maintaining the integrity and accuracy of the data.
• Must complete background check and Livescan.
• Covid-19 vaccine and booster is required for this position. Exemptions are not accepted.
• We will consider for employment qualified applicants with arrest and conviction records.