Senior Manager of Revenue Cycle

The Revenue Cycle Senior Manager is responsible for leading the day-to-day revenue cycle management (RCM) program for the organization. This position is responsible for management of the medical billing and revenue cycle management department including claims processing, revenue monitoring and quality improvement initiatives. Works cooperatively with other departments to ensure timely billing, reporting and patient account management. Supports the organization’s strategic plan and workplace inclusion initiatives. Abides by the organization’s mission in performing job duties. Demonstrates an understanding and commitment to PPGT’s culture of quality, safety and risk awareness.

• Oversees the organization’s RCM operations for insured, funded and self-pay patients including satisfying timely filing requirements and maximizing billing revenue and collections, managing appeals and resolution of denied or rejected claims.
• Tracks, monitors and reviews Key Performance Indicators (KPIs) with Finance, Patient Access and Health Services on a monthly basis and documents actions in monthly department meeting minutes.
• Ensures insurance payments and reimbursements meet current fee schedules and ensures payer contracts are updated in the Electronic Practice Management (EPM) system as needed.
• Supervises the Revenue Cycle Billing Specialists.
• Collaborates with the Finance department to monitor Accounts Receivable (A/R) aging, unpaid claims and payment reports to identify trends and underpayments, investigates causes and takes appropriate steps toward resolution.
• Serves as the liaison with Patient Access, Finance and Health Services leaders to develop processes and priorities for continuous quality improvement to improve revenue cycle outcomes.
• Ensures quality review and billing audits are completed at least annually, creates corrective action plans and communicates results with Finance, Health Services, Patient Access, and Risk and Quality Management (RQM).
• Provides monthly updates of revenue cycle status, including reports and metrics to Finance and Operations Leaders.
• Manages and provides oversight of third-party RCM vendor to ensure the following:
o Charges are accurately captured and documented
o Claims are appropriately submitted to the clearinghouse
o PPGT policies and protocols are being followed to maximize accuracy of claims and minimize denials.
o KPIs are met
• Tracks and reviews payer denials and works with health plans to resolve denials, appeals, or underpayments.
• Collaborates with Finance to monitor write-offs, collection and refund processes to ensure accurate patient accounts and timely refunds.
• Works with Finance and Health Services to ensure accurate patient accounts for funding programs.
• Maintains an understanding of the insurance verification process for all health centers and collaborates with Patient Access and Health Center leadership as needed.
• Tracks incoming and outgoing patient calls to resolve patient balances and monitors for trends. Ensures patient messages are returned within 24-48 hours and provide staff with ongoing customer service and collections training.
• Tracks correspondence and returned mail volume and ensures patient account demographics are updated with new addresses, returned mail indicators, and billing alerts when needed.
• Monitors patient statement volumes to ensure patient statements are processed in a timely manner.
• Identifies opportunities for improvement and partners with the Clinical Applications team, third party RCM vendor, or any other vendor as indicated, to optimize use and resolve issues within the Electronic Practice Management (EPM) system, clearinghouse, and payer portals.
• Has unrestricted access to paper and electronic patient protected health information (PHI) and health records for purposes of treatment, payment, and/or healthcare operations. The use of a patient’s protected health information should be limited to information needed for the specific task that is being performed or requested by the individual patient. Disclosure of any patient information must be for purposes of treatment, payment or healthcare operation OR must be accompanied by a valid patient authorization. Must adhere to minimum necessary rule.
• Embraces the organization’s “In This Together” customer service standards and uses them with internal and external customers, every person, every time.
• Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally, either verbally or in writing.

Bachelor’s degree + 2 years of relevant exempt experience or Associate’s degree + 4 years of relevant exempt experience or High School diploma (or equivalent) + 6 years of relevant exempt experience. Relevant exempt experience: revenue cycle manager, patient access center manager, accounts receivable manager or medical office manager experience. Revenue cycle manager experience preferred. Electronic practice management system experience preferred.

Revenue Cycle Management certification preferred

Must be able to work primarily with fingers such as picking, pinching, or typing. Must be able to talk such as convey detailed or important spoken instructions to other workers accurately. Must be able to hear such as the ability to receive detailed communication orally. Must be able to communicate effectively. Will have substantial movements of the wrists, hands, and/or fingers. Must be able to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading. Sedentary/Office environment.

• Must be able to work the organization’s hours of operation or as required.
• Must be able to travel as required.
• Excellent customer service skills and commitment to providing the highest level of customer satisfaction.
• Ability to successfully handle a high volume of accounts.
• Must be knowledgeable with the principles and practices of revenue cycle management.
• Strong organizational skills and ability to multi-task.
• Ability to think strategically and achieve organization’s goals relating to position.
• Ability to provide oversight of compliance and regulatory requirements pertaining to position.
• Strong organizational skills and ability to multi-task.
• Ability to manage intense stress with multiple competing priorities while maintaining a positive attitude and affect.
• Ability to effectively use organization’s computer systems.
• Ability to manage details and complexity, to handle a variety of tasks simultaneously and to work under pressure.
• Skilled in verbal and written communications.
• Ability to exercise initiative, sound judgment, and problem-solving techniques in the decision-making process.
• Be discreet and safeguard confidential information.
• Possess integrity and compliance – can be relied upon to act ethically.
• Effective leadership capabilities; able to mentor and coach team in area of responsibility and the achievement of organization goals.
• Ability to provide effective, equitable, understandable, and respectful quality care and services that are responsive to the diverse cultural health beliefs and practices, preferred language, health literacy and other communication needs.
• Industry Awareness: Remains aware of Planned Parenthood Federation of America (PPFA) accreditation standards and of the reproductive health environment’s regulatory compliance requirements. Understands how accreditation standards, regulatory agencies, funding, the external marketplace and competitive environment drives change within the organization .
• Organizational Awareness: Demonstrates a comprehensive awareness of the impact and implications of decisions and actions on other areas (departments or clinics) within the organization.
• Work Management: Effectively manages time as a resource; establishes realistic priorities; schedules own time and activities effectively; gives balanced focus and attention to appropriate long- and short-term priorities. Develops action plans and budgets; leverages technology; anticipates obstacles; establishes check points and monitors progress.
• Recovery Skills: Responds effectively and acknowledges responsibilities when clients (internal or external) experience problems or mistakes; rectifies the situation to restore client satisfaction; seeks information and collaborates with others to take action to implement permanent fixes. Maintains stable performance and emotions when faced with opposition, pressure, and or stressful conditions.
• Interpersonal Sensitivity: Acts in a way that indicates understanding and accurate interpretation of others’ concerns, feelings, strengths and limitations. Uses interpersonal understanding to shape one’s own response.
• Building Relationships: Shows genuine interest in others’ needs and opinions; establishes rapport; earns the confidence and trust of others; demonstrates consistency between words and actions; delivers on commitments.
• Process Improvement: Understands core work processes; identifies process opportunities and issues; seeks information to understand the gap between current and desired performance; works effectively with others to identify and implement improvements; continuously works to improve returns for the client and the organization.
• Adaptability or Flexibility: Responds with flexibility to shifting priorities and changing work situations; recovers quickly from problems and setbacks; develops new skills to remain competitive. Adapts easily to change, sees the merits of differing positions, and adapts own positions and strategies in response to new information or changes to a situation.
• Exemplify the organization’s In This Together values: We Tend to the Team; We Respect and Honor All People; We Jump In; We Try and We Learn; We Care for our Business; and We Return to our Mission.

Must have excellent computer skills with knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and Internet. Must have the willingness and ability to adapt to change including advances or new technology. Must have excellent customer service skills and be committed to providing the highest level of customer satisfaction. 

Other

PPGT is an equal opportunity employer.  We strictly prohibit unlawful discrimination of any kind, including discrimination on the basis of age; race, color, ancestry, national origin, or ethnicity; citizenship status; sex or gender; gender identity or gender expression or transgender status (including the individual's actual or perceived sex and the individual's gender identity, self-image, appearance, behavior, or expression); sexual orientation (including actual or perceived heterosexuality, homosexuality, bisexuality and asexuality); mental or physical disability; AIDS, AIDS Related Complex, or HIV status; perception of risk of HIV infection; or association with individuals who are believed to be at risk; religion or creed; genetic information; pregnancy status, including related medical conditions; marital status; past, current, or prospective service in the uniformed services; or any other basis protected by law.  We are a drug-free and tobacco-free workplace.

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