Revenue Cycle Manager(RCM)

• GENERAL SUMMARY OF DUTIES: Manages patient account and reimbursement services for the agency that requires third party and other billing related functions. Develop, implement, and enforce policies and procedures, as well as streamlining effective billing processes (with the exception of grants and contracts).
• This position is highly visible and requires a strong leader with the ability to prioritize, plan, manage, follow-up, report, communicate, and direct the department. Must have a proven track record for improving process efficiencies, identifying gaps, solving problems, and communicating to executive lea
• SUPERVISION EXERCISED: Manages the Billing Department-Revenue Cycle Management, Days in AR, Reconciles and identified front end and back-end issues and escalates appropriately. The Revenue Cycle Manager is responsible for the overall management, condition, and evaluation of the Revenue Cycle. Directly supervises employees who support the revenue cycle process. Carries out managerial responsibilities in accordance with the agency's policies and applicable laws; responsibilities include interviewing and training employees, planning, assigning and directing work; appraising performance, rewarding and disciplining employees, addressing complaints and resolving problems.

ESSENTIAL FUNCTIONS: The RCM will perform the following duties personally or through subordinates.

• Oversee and optimize centralized billing operations, supervising all related roles for Medical and Dental Billing that's comprised of Central Office Billing.

• Formulate, assess, and update billing and reimbursement policies and procedures based on changes in laws, policies, and under the advisement of supervisory and executive staff.

• Maintain confidentiality and adherence to standard accounting practices in accounts receivable.

• Uphold stringent internal control measures over accounts receivables.

• Secure cash payment processes and assure all processes are followed.

• Track and manage collections, insurance claims, and third-party payments.

• Analyze and ensure compliance with third-party reimbursement policies; investigate and escalate discrepancies.

• Stay current with CMS policies and third-party contracts, private insurers, and government regulations.

• Solves operational issues and customer service issues in coordination with supervisor.

• Ensure that all critical issues are escalated to the Director of Finance and executive team.

• Support training and communication initiatives for Front Desk operations, Practice and Operations Management, and provider staff.

• Collaborate with external stakeholders for financial studies and audits concerning patient accounts.

• Manage charge postings, denials, billing, and collections for outpatient services, enforcing consistent policy application and reimbursement consistent with services rendered.

• Develop and conduct staff training and development programs to include evidence of gaining new knowledge.

• Organize staff schedules to guarantee optimization of the revenue cycle based on size, scale, and scope of the medical and dental practices.

• Host departmental meetings to communicate procedural changes as often as necessary.

• Collaborate with the financial and executive leadership on issues that impact the organizational budget and organization's strategic plans.

• Conduct research and procurement for necessary business tools or business intelligence that support and enhance the department.

• Serves as liaison between the department and other departments as needed to insure the best billing practices and compliance across the organization.

• Meet with the clinical and credentialing department regularly to insure they are aware of any issues related to denials or coding.

• Ensure that activities of the department align with the organization's budget and strategic plans.

• Compile and present detailed reports and analyses on billing, collections, and reimbursements.

• Participate in HRSA, Joint Commission, and other accrediting bodies on all audits that occur in the organization.

• Implement metrics and KPIs (Key Performance Indicators) to monitor and report on the efficiency and effectiveness of billing operations.

• Develop strategies for reducing the time from service delivery to payment receipt.

• Engage with IT department to leverage technology in improving billing processes, ensuring system optimization and data integrity with coordination of supervisor.

• Foster a culture of continuous improvement, encouraging innovation and efficiency in billing processes.

• Evaluate customer satisfaction regarding billing issues and develop strategies to enhance the patient financial experience.

• Negotiate and manage contracts with insurance payers, including Medicaid, Medicare, and private insurers, to ensure favorable reimbursement rates and terms for the FQHC.

• Develop strategies for reducing denials and improving the appeals process. Analyze denial patterns to identify root causes and implement corrective actions to prevent future denials.

• Perform regular financial analyses to track the health center's performance. Use data to identify trends, opportunities for improvement, and areas of concern in the revenue cycle.

• Work closely with clinical staff and the billing team members to ensure accurate documentation and coding for services rendered, facilitating appropriate billing and maximizing revenue.

• Ensure compliance with HIPAA and other relevant regulations concerning patient financial information.

• Prepare and present billing department status reports to the Director of Finance and CFO monthly.

• Mentor and develop billing department staff and foster a team-oriented environment.

• Communicate with key stakeholders, third party managed care contracts to align services with reimbursements.

• Communicate, report, track, and monitor transactions with electronic medical record vendors for reporting or recording for timely billing.

• Oversight of billing, coding, and documentation geared towards first pass clean claims as contracted.

• Fulfill additional responsibilities as designated by the CFO or CEO.

• QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty optimally. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION/EXPERIENCE:

Bachelor's degree from a four-year college or university in Finance, Business Administration, Health Information Management, or a related field; or an equivalent combination of education and experience in a relevant area.

A minimum of three (3) years of direct experience in billing and coding, with a strong emphasis on practical application and hands-on training in this field. Current certification as a Certified Biller and Coder, with a commitment to maintaining this certification and staying abreast of industry changes.

KEY COMPETENCIES:

CRITICAL THINKING AND PROBLEM SOLVING: Ability to analyze complex billing scenarios, identify discrepancies, and develop effective solutions. The candidate should demonstrate a track record of resolving billing issues efficiently and creatively.

COLLABORATION AND COMMUNICATION SKILLS: Strong ability to work cohesively with a team, including cross-departmental collaboration. Excellent verbal and written communication skills are essential for effectively conveying billing information and resolving issues with clients and team members.

ANALYTICAL SKILLS: Proficiency in analyzing billing data, interpreting trends, and making data-driven decisions. The candidate should be adept at using analytics to improve billing processes and outcomes.

Use of technology and software to assist with analysis.

BUSINESS INTELLIGENCE: Strong skills in business intelligence tools and technologies relevant to billing and coding. The candidate should be able to leverage BI tools to enhance billing accuracy, efficiency, and compliance.

• dership, peers, colleagues, and key stakeholders.