Revenue Cycle Manager

Position Title: Revenue Cycle Manager

Summary: Oversees all aspects of daily operations of the Revenue Cycle department. Directly supervises all Coding & Billing department staff and the Patient Accounts Supervisor. Ensures all Revenue Cycle functions of the Clinic and Surgery Center are accurately and efficiently performed in a timely manner to maximize reimbursement due to the Bone & Joint companies in accordance with established payer agreements, and cash payment rates. Ensure our billing and coding practices remain compliant with government rules and regulations, payer polices and industry standards. Actively supports the Bone & Joint Leadership Mission and Vision Statement and the Bone & Joint Strategic Plan.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

Quality:

1. Responsible for the accuracy and timeliness of all Revenue Cycle functions including coding, billing, and reimbursement for clinical, therapy, ancillary and Ambulatory Surgery Center (ASC) services of a multispecialty Musculoskeletal practice, including Orthopedics, Pain Management and Podiatry.
2. Accountable to ensure operational efficiencies, workflows, system enhancements and quality. Focus on people and process performance that constantly strives to eliminate waste, improve patient and provider satisfaction via the use of continuous improvement tools and methodologies.
3. Stay up to date with current coding, billing, payer requirements and federal and state regulations related to billing and collections.
4. Maintain an Audit process for coding, billing, accounts follow-up, payment posting and other functions to monitor the quality and quantity of work performed by the Revenue Cycle department.
5. Work with providers, clinical staff, coders, billers, HIM on coding and documentation issues, along with payer guidelines to assist improving the quality of coding and documentation.
6. Engages with Bone & Joint's Practice Management system vendors along with leadership and IT to maximize system utilization and functionality.
7. Coordinate and manage external audits and reviews conducted on Bone & Joint Revenue Cycle systems, processes and workflows.
8. Has oversight on report development and monitoring of key metrics to ensure appropriate workflows are in place so that Revenue Cycle processes are both efficient and effective. Interfaces with Finance/Decision Support to develop reports and analysis as may be needed to appropriately monitor results.
9. Monitor end of month (EOM) processes to ensure minimum backlog for EOM processing. In coordination with the Patient Accounts supervisor, this will include working with providers, HIM, billers, coders, payment posters, and Finance Department to ensure all eligible charges are entered by the EOM cut-off date.
10. Oversight on refunds, adjustments and write-offs to ensure that they are accurate, timely and within expected limits. Work with management on variances and unique situations.
11. Establish procedures, signing authority limits for write-offs and refunds.
12. Assist management to establish checks and balances in the processes and online system to avoid potential risk to the practice.
13. Understand and engage with payer networks as necessary on relevant Revenue Cycle matters.
14. Be well versed in contracted payer networks and our practice's payer contracts and their key provisions.
15. Maintain a strong understanding of Medicare guidelines and respective reimbursement levels. Communicate changes to all necessary providers and staff.
16. Oversight on coordinating and filing of Payer Dispute forms with ANI for incorrect payer denials or other contractual related issues where ANI's intervention is needed.
17. Responsible for development of department policies and procedures. Supports organizational policies and procedure development as requested.

People:

1. Responsible for direct supervision of the Coding Lead, Coders & Billers, and Patient Accounts Supervisor. Supports the Patient Accounts Supervisor's team to meet operational needs.
2. Act as a key resource for questions related to the revenue cycle for all staff, management, and providers.
3. Interview, hire, schedule, and train excellent staff, using hiring techniques available to our hiring supervisors.
4. Perform 30-, 60- and 90-day orientation reviews for new staff.
5. Set schedules and work locations for staff to meet practice needs, and accommodate staff needs whenever possible.
6. Coach staff and work to raise low performers to required standards and performance levels using organizational guidelines. Support retention of high performing staff.
7. Provide annual performance evaluations to staff, meeting the practice guidelines for timely completion.
8. Assess and establish disciplinary processes, where indicated, by staff performance.
9. Cross-train all functions to ensure continuity of service in the event of leaves or other absences.
10. Lead monthly Revenue Cycle Group meetings and/or weekly Coding/Billing team huddles to provide information, general updates, and policies and procedures to staff. Supports the Patient Accounts Supervisor on Patient Account team huddles.
11. Round on employees per organizational targets. Round on patients as may be required by organizational initiative.
12. Participate in inter-departmental meetings, projects and other needs as requested.

Service:

1. Analyze the Accounts Receivables Aging to determine payer trends and issues. Develop reports and processes to detect billing and reimbursement delays.
2. Research and develop workflows collaboratively with department leadership for ever-changing coding, insurance billing, collections, and accounts follow-up requirements.
3. Assist Revenue Cycle staff to resolve payer issues which prevent our claims from being paid the first time they are submitted.
4. Provide reports to management as required.
5. Work with leadership from Registration and Verification of Benefits/ Precertification for accurate Patient demographics and insurance information that will ensure claims are billed correctly the first time.
6. Oversee and assist with patient complaints and/or service recovery efforts when they involve the Patient's charges and balance or whenever requested.
7. Participate in and/or provide information or reports to the Board of Directors and Leadership, as requested.
8. High level of research, analysis and problem-solving skills.
9. Engages with other department leaders to coach and inform them of opportunities and/or concerns that impact Revenue Cycle processes or expectations.

Growth:

1. Look for system tools and enhancements that will offer greater efficiencies and accuracy of every aspect of the revenue cycle, as well as helping management to assess the potential for reducing FTEs and/or reassigning staff.
2. Assist management in planning and implementation for new services, service lines and/or locations.
3. Raise expectations and results of performance for yourself and your staff through ongoing training, coaching, and other staff development initiatives.
4. Assist with development and participation with projects and other practice needs.

Finance:

1. 1. Review and have signatory responsibility for write-offs, adjustments and refunds as dictated per financial policy and procedures, reviewing discrepancies and/or unusual circumstances with management and administration.
   2. Achieve and maintain days outstanding in A/R according to the practice's chosen benchmark, such as MGMA standards, OrthoConnect survey, etc.
   3. Maximize revenues by efficient workflows and assessing contractual to actual payments.
   4. Enhance revenues by assisting management with coding and billing for new services and/or service lines.
   5. Prepare annual Revenue Cycle department budget(s) for staffing, expenses, and capital equipment. Assist organizational budgeting initiatives as may be requested.
   6. Assist management in cost containment, meeting financial goals, and maintaining low budget-to-actual variance.
   7. Manage external Revenue Cycle vendor relationships and pricing to ensure Bone & Joint is adequately supported at a reasonable price point that enable us to best manage costs.

Education/Experience

1. Bachelor's Degree in Business or Healthcare Administration, or equivalent experience strongly preferred.
2. Five to ten years of experience in healthcare business office/management in a continuously growing organization is required.
3. 2-5 years' experience in medical coding & billing, including insurance billing requirements, CPC certificate desired.
4. 2-5 years' experience working aged accounts receivables.
5. 2-5 years' experience ICD 10 CM and CPT coding or coding knowledge needed to bill and work aged accounts.
6. Knowledge and ability to work with commercial, Workers Compensation and government payers.
7. 1 years' Ambulatory Surgery Center billing and aged A/R experience preferred, including both CMS and UB claims requirements for ASCs.
8. Ability to work with the payers, the network, the Patients and staff throughout the organization at all levels.
9. 2-5 years' experience working with payer contractual reimbursement levels.

Qualifications:

1. Minimum of 5 years of revenue cycle leadership experience in a health care related field required, strongly preferred.
2. Medical coding & billing and accounts receivables supervision in an orthopedic practice preferred.
3. Experience with AthenaPractice (f/n/a GE Centricity Practice Solution) practice management system and HST Pathways helpful.
4. Must have a valid driver's license and able to travel to all locations of Bone & Joint as needed.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to stand; walk; sit; use hands to type; and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch and bend. The employee must occasionally lift and/or move boxes up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Essential Physical Requirements

All responses use the following codes:

N = Never

O = Occasional, represents 1 to 33% or 1 to 2 hours of an 8 hour workday.

F = Frequently, represents 34 to 66% or 2½ to 5½ hours of an 8 hour workday.

C = Continuously, represents 67 to 100% or 6 to 8 hours of an 8 hour workday.

PHYSICAL ACTIVITY

Walking: O

Standing: O

Sitting: C

Reaching Shoulder Height: O

Reaching Above Shoulder Height: O

Reaching Below Shoulder Height: O

Climbing: N

Pulling 25 Pounds or Less: O

Pulling 25 Pounds to 50 Pounds: N

Pulling Over 50 Pounds: N

Pushing 25 Pounds or Less: O

Pushing 25 to 50 Pounds: N

Pushing Over 50 Pounds: N

Lifting 25 Pounds or Less: O

Lifting 25 Pounds to 50 Pounds: N

Lifting Over 50 Pounds: N

Carrying 25 Pounds or Less: O

Carrying 25 Pounds to 50 Pounds: N

Carrying Over 50 Pounds: N

Crawling/Kneeling: N

Bending: O

Twisting/Turning: O

Balance: N

Repetitive Movement (fine motor like typing, writing, keyboarding, filing): C

PHYSICAL EXPOSURE

Unprotected Heights: No

Lighting Bright: Yes

Lighting Dim: No

Mechanical Hazards: No

Hazardous Substance: No

Infectious Diseases: No

Harmful Physical Agents (Heat/Cold): No

Noise: No

Ionizing/Non-Ionizing Radiation: No

PHYSICAL ABILITY-ACCEPTED MINIMUM

Vision: Good

Color Vision: Impaired

Hearing: Normal

Manual Dexterity: Good

Talking/Speech: Good