Revenue Cycle Manager

REPORTING RELATIONSHIP:

Supervised by:                  Administrator

Positions Supervised:     Support service positions, including billing and revenue cycle-related staff

Interrelationships:           IDT and other health care team members

JOB SUMMARY:

The Revenue Cycle Manager reports to the Administrator and possesses the qualifications and abilities to complete all of the below functions and others as assigned by the Administrator. The Revenue Cycle Manager will be responsible for planning, directing and coordinating billing, coding, accounts receivable, financial and other reporting, financial-related quality assurance projects, coordinating with credentialing staff insurance contracting, overseeing payor verification and authorizations. Much of this may be accomplished by supervision of others completing these tasks. However, Revenue Cycle Manager is responsible for developing an effective program to manage billing and accounts receivable in its entirety.

QUALIFICATIONS:

Educational/Degree:                     

Associates or bachelor’s degree from an accredited university in a healthcare or related field, preferred. Experience in lieu of education may be considered.

Knowledge/Skills/Ability:             

Ability to work well with a team of healthcare professionals. High proficiency with technology. Ability to lead and/or supervise other team

members as assigned. Ability to maintain accuracy of work in a fast paced environment. Ability to multitask. Energetic and willing to go above and beyond for other team members. Ability to focus on financial business processes efficiently and with excellent attention to detail.

Experience:                                       

At least three (3) years of experience in health care, billing, and/or Hospice. Experience in a leadership role, preferred.

ESSENTIAL FUNCTIONS:

1. Assists Leadership team in continued development and implementation of an effective billing and revenue cycle system.
2. Utilizes appropriate forms/systems for billing preparation and submission. Creates and improves systems for maximum efficiency, productivity, and ease of replication/expansion with business growth.
3. Coordinates the verification of insurance benefits, billing, collection, and cash application of all Hospice and Palliative care services per established procedures and regulatory requirements.
4. Investigates, implements, and maintains current technology with Medicare, Medicaid, and Commercial Insurances for electronic verification of benefits, electronic submission of claims and electronic remittances.
5. Recruits, orients, trains, evaluates, and monitors the on-the-job performance of assigned staff.
6. Ensures all billing staff document relevant information and any communication with other agencies, billers, or payors in the correct areas, forms and/or the medical record.
7. Serves as the primary contact with representatives of payor sources to assist in resolving billing and contractual issues and completion of payor-required reports.
8. Serves as a leader and primary resource to staff for billing information and/or interpretation issues.
9. Identifies need for staff education in billing-related functions and assists in the development and/or procurement of inservice and training programs.
10. Acts as a resource for electronic medical record system and educates staff in components of the medical record on both the office side and on the clinical side as it relates to billing and/or quality.
11. Assists with or delegates the filing of documentation into the appropriate patient chart in the electronic medical records system.
12. Completes and assigns all portions of daily checklist(s) for billing and revenue cycle management.
13. Submits timely billing of all patient accounts for Hospice and Palliative care services for all payors.
14. Oversees and maintains timely and accurate billing and payment of nursing home room and board charges.
15. Oversees the month-end billing and audit processes to ensure accuracy of patient billing.
16. Reviews pre-bill holds, validation holds, claims errors, and other barriers within the electronic medical record to resolve issues for timely and accurate billing.
17. Reports claims holds and other claims issues with the appropriate team members via the appropriate channels to ensure timely follow up. Inform managers of issues so appropriate action can be talent to prevent issues in the future.
18. Submits and/or oversees submission of timely notices of election, notices of revocation, notices of transfer, etc. and all required submissions to all payors to allow for timely billing.
19. Maintains accurate payor source information and billing rates in electronic medical records software and on all tracking forms.
20. Reports any payor issues to appropriate team members via appropriate communication channels.
21. Works with electronic medical record system and other intermediaries to enroll and configure all payor setups, update payors, rates, etc. as needed for billing.
22. Maintain the Payors Overview Sheet with all accurate and up-to-date information regarding all payors.
23. Maintains the Billing Checklist(s) and processes/procedures for the Billing Team.
24. Manages administrative checklists for admissions, discharges, transfers, revocations, and deaths and follows up to ensure all components of the patient record are entered accurately and timely for billing.
25. Contacts families if required to gather more financial-related information or for questions related to billing. Acts as a point person for financial issues with patients and their families.
26. Monitor biller performance and provide reports to the Administrator as requested.
27. Prepares, analyzes and/or presents as needed reports related to finance, budgeting, quality and other areas of financial operations.
28. Submits data to Medicare, Medicaid, and other payors as assigned.
29. Manages accounts receivable to ensure maximum available cash on hand.
30. Reviews for accuracy the month end revenue report(s) and other reports for the Accounting and Leadership teams.
31. Oversees billing and collection activities to maintain Days Revenue in A/R within acceptable ranges as established by the Leadership team.
32. Retrieves all remittance advice and posts cash in the electronic medical record system (or ensures automatic posting). Ensure all deposits are logged in the appropriate tracking form and reconciles deposits received with bank accounts, communicating with Corporate Accounting as needed.
33. Monitors 835 vs. catch batches report from Matrixcare, and the monthly audit Sheet. Communicates with billers to solve any discrepancies.
34. Assists with identifying, collecting, and reporting relevant statistical data to reflect Accounts Receivable activities.
35. Completes special assignments/projects as assigned.
36. Displays a willingness to support current processes and procedures and uses appropriate channels for implementing new processes and/or procedures.
37. Observes confidentiality and safeguards all patient related information.
38. Accepts responsibility for regular attendance and punctuality.
39. Coordinates his/her own schedule and the schedule of the billing team to assist in staffing the in-person office when coverage is needed by way of monitoring attendance calendar for key office staff upcoming days off.
40. Has ability to utilize iPad, laptop, PC, and electronic medical records system, among other technological components of job.
41. Possesses willingness to work as part of the team.
42. Fulfills job-related requirements without regard to time involved.
43. Performs other tasks as assigned by the Administrator.