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- Lexington, KY 40517
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Revenue Cycle Manager
Kentucky Medical Services Foundation • Lexington, KY
Posted 2 days ago
Job Title: Revenue Cycle Manager
Job Status: Full-Time, Exempt
Department: Revenue Cycle Management
Immediate Supervisor Title: Senior Revenue Cycle Manager
Job Supervisory Responsibilities: None
General Summary: The Revenue Cycle Manager serves as the primary contact between assigned clinical practices and the KMSF Professional Billing Office on all aspects relating to the billing and collection of professional services.
Job Duties and Essential Functions:
1. Financial Analysis
a. Provides in-depth analysis of comparative data to support decisions impacting the effective operation of assigned clinical practices.
b. Identifies negative trends and offers ideas and solutions for their reversal and resolution, whether with the department(s), the billing office, or the payer(s).
c. Communicates identified trends and other results of analysis with appropriate faculty, administrative staff and leadership.
d. Develops methods and tools for analyzing, synthesizing, and forecasting the revenue cycle.
e. Facilitates and assists assigned clinical practices on the annual budget preparation, analysis, and review.
f. Evaluates and assists in explanation and interpretation of standard operational, financial, billing, and budget statistical data against budget and benchmark criteria relative to assigned clinical practices for month-end close meetings.
g. Identifies opportunities for improvement and streamline workflows to optimize performance.
2. Reimbursement Analysis
a. Initiates analyses to understand shifts in payor and service mix and provide expert guidance on maximizing collections through data analysis (contracts and reimbursement rates).
b. Provides effective analysis of AR, denial, and reimbursement trends, and provides guidance for reversing and resolving any negative trends to provide recommendations and solutions.
c. Provides updates on global issues regarding coding and reimbursement practices.
d. Reviews and monitors reimbursement trends to assess impact of new regulations or codes from a coding, compliance and reimbursement perspective.
a. Supports and upholds the overall mission of Kentucky Medical Services Foundation.
b. Establishes and manages effective on-going communication and education with assigned clinical department providers (Department Chairs, Division Chiefs, staff physicians, Advanced Practice Providers, Department Administrators, and departmental billing staff) on issues regarding billable services. Communicates the enforcement or revision of revenue cycle policies and procedures, conveying coding guidelines and documentation requirements, including CPT, CMS, and federal, specialty, and payer requirements.
c. Interprets, implements, and communicates changes in carrier/payer reimbursement and payer rules to clinical department customers.
4. Collaborates with assigned clinical departments on day-to-day front end revenue cycle operations.
5. Serves as the primary internal escalation point for unresolved department and division issues.
6. Continuously evaluates and offers suggestions in the development of more effective analytical tools.
7. Serves as a resource in the development and improvement of more accurate charge capture tools.
8. Maintain confidentiality of all patient demographic, medical, and financial information. Ensure proper handling and disposal of confidential documents and adherence to all HIPAA rules and regulations.
Education Requirement: Master’s Degree preferred. Undergraduate degree in healthcare, business administration, or related field required.
Experience Requirement: Minimum of two to three years’ experience with financial analysis, forecasting and oversight required. For internal candiates, one year as in the role of Revenue Cycle Analyst equates to two years of financial analysis, forecasting and oversight.
Other Requirements: Valid Driver’s License and reliable transportation for local job-related travel
Equipment Operated: Standard office equipment including computers, copiers, printers, telephones, etc.
Work Environment: Work may be performed in a variety of temperature-controlled, well-lighted office and clinical environments and may require occasional evening and weekend work.
Mental/Physical Requirements: Involves sitting approximately 90 percent of the day, walking or standing the remainder.
Knowledge, Skills & Abilities:
1. Must possess and exhibit the self-confidence, poise, and professionalism necessary to effectively interact, communicate, and collaborate with the various levels of enterprise leadership. Must be experienced with executive level presentation skills and public speaking.
2. Must possess, demonstrate, and continue to develop solid analytical skills.
3. Must demonstrate proficient use of MS Office Suite products and the ability to learn and become proficient in the use of other software and reporting tools that will be used routinely.
4. Must demonstrate the ability to –
a. Interact and communicate effectively in a clear and concise manner with diverse groups of business associates
b. Analyze and synthesize large amounts of data
c. Identify trends, interpret their meaning, and offer ideas and solutions
d. Work both independently and in team environments / projects
e. Manage time effectively, multi-task and manage competing priorities
f. Meet deadlines
5. Will be expected to possess and/or acquire knowledge and understanding of the following:
a. Medical professional fee billing guidelines and compliance thereto
b. CPT, HCPCS, ICD-9, ICD-10
d. Teaching rules
e. Payor edits
g. Accounts Receivable
h. Co-pays, Co-Insurance and Deductibles