MANAGER RCM & CREDENTIALING

Description

Are you looking for a purpose-driven career? At Metrocare, we serve our neighbors with developmental or mental health challenges by helping them find lives that are meaningful and satisfying.

Metrocare is the largest provider of mental health services in North Texas, serving over 55,000 adults and children annually. For over 55 years, Metrocare has provided a broad array of services to people with mental health challenges and developmental disabilities. In addition to behavioral health care, Metrocare provides primary care centers for adults and children, services for veterans and their families, accessible pharmacies, housing, and supportive social services. Alongside the clinical care, researchers and teachers from Metrocares Altshuler Center for Education & Research are advancing mental health beyond Dallas County while providing critical workforce to the state.

The mission of Metrocare Services is to serve our neighbors with developmental or mental health challenges by helping them find lives that are meaningful and satisfying. We are an agency committed to quality gender-responsive, trauma-informed care to individuals experiencing serious mental illness, development disabilities, and co-occurring disorders. Metrocare programs focus on the issues that matter most in the lives of the children, families, and adults we serve.

The RCM And Credentialing Manager is responsible for managing all activities within the revenue cycle management function for the Agency. RCM processes include but are not limited to insurance verification, authorizations, patient statements, charge entry/coding, submission of clean claims, collection of patient and insurance receivables, patient and operation communications, and credentialing.

The RCM And Credentialing Manager will oversee the specialists that are responsible for system support tasks related to RCM and Credentialing that may result in the need to provide end user support, testing, documentation, and general support of the Electronic Health Record. Responsibilities also include implementing and maintaining an efficient workflow within the practices as well as ensure that all employees within the department have received the proper level of training to complete their daily tasks including cross training in other departments to ensure the highest level of accuracy and efficiency. This position reports to the Chief Information Officer and works with multiple stakeholders to identify and implement enhancements to the application in support of patient care.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

The essential functions listed here are representative of those that must be met to successfully perform the job.

• Assess new acquisition revenue cycle processes.
• Identify opportunities with RCM systems.
• Work with our MSO in the development of streamlining processes and maintain accurate and timely billing processes.
• Create and implement metrics for productivity and quality.
• Ensure adherence to and compliance of payor, government, and internal system regulatory policies.
• Monitor key revenue cycle management performance levels for each team member as well as each RCM team.
• Conduct routine monitoring and auditing activities to ensure staff production goals and quality of work is met.
• Conduct streamlined communication processes with practice RCM teams, Practice Administrators, RCM leadership, and various departments across the organization.
• Carry out supervisory responsibilities in accordance with company policies.
• Oversees system support for internal operational users of the EHR software system.
• Oversees issues and supports users as needed.
• Oversees the ongoing maintenance of the EHR Configuration, tests, and implementation of updates to system.
• Assists with identification and implementation of enhancements in support of Operations.
• Works with leadership to prioritize issues and enhancement requests.
• Assists with RCM issues and implements fixes.
• Ensure all statements, calls and refunds are current.
• Communicates effectively with internal Operations teams and follows-up, when needed.
• Oversees and supports the Medical Receptionist who manages patient calls and assists with troubleshooting.
• Assist with Follow-up issues with patients if their claim is pending, or if they have an issue to resolve.
• Monitors issues with patient statements.
• Assists with all billing-related issues and follows-up until fix is implemented.
• Assist with Finance tasks related to Clinical Collections/Payments.
• Performs other duties as assigned.

COMPETENCIES:

The competencies listed here are representative of those that must be met to successfully perform the essential functions of this job.

• Conducts job responsibilities in accordance with the ethical standards of conduct, state contract, appropriate professional standards and applicable state/federal laws.

• Analytical skills, professional acumen, business ethics, thorough understanding of continuous improvement processes, problem solving, respect for confidentiality, and excellent communication skills.
• Effective verbal and written communication skills.
• Excellent organizational skills with the ability to prioritize workflow and meet deadlines.
• Ability to handle multiple tasks and special projects simultaneously.
• Able to work autonomously with minimal or no supervision.
• Able to maintain a high level of professionalism and confidentiality.

QUALIFICATIONS

EDUCATION AND EXPERIENCE:

• Preferred: Bachelors degree in business, Health Management, or related field plus 5 years Revenue Cycle experience.
• Required: Minimum of 10 years of RCM Billing/Credentialing experience.
• Experience with health care systems.
• Experience with accounts receivable/understanding of the revenue cycle.
• 7 years of experience dealing with EHR system.

MATHEMATICAL SKILLS:

• Basic math skills required.
• Ability to work with reports and numbers.
• Ability to calculate moderately complex figures and amounts to accurately report activities and budgets.

REASONING ABILITY:

• Ability to apply common sense understanding to carry out simple one or two-step instructions. Ability to deal with standardized situations with only occasional or no variables.
• Ability to function in a fluid environment and respond appropriately to changing priorities.
• Demonstrate high ethical standards in all professional relationships within the organization and outside of it.
• Able to identify issues and effectively problem solve.

COMPUTER SKILLS:

• Use computer, printer, and software programs necessary to the position (i.e., Word, Excel, Outlook, and PowerPoint).
• Ability to utilize Internet for resources.
• Intermediate skills with Microsoft Office Suite
• Ability to utilize Internet for resources.
• Excellent data entry skills.

CERTIFICATIONS, LICENSES, REGISTRATIONS:

• Current State of Texas Driver License or if you live in another state, must be currently licensed in that state. If licensed in another state, must obtain a Texas Driver License within three (3) months of employment.
• Liability insurance is required if an employee will operate personal vehicle on Center property or for Center business. Must be insurable by Centers liability carrier if employee operates a Center vehicle or drives personal car on Center business. Must have an acceptable driving record.

Metrocare couldnt have a great employee-first culture without great benefits. Thats why we offer a competitive salary, exceptional training and an outstanding benefits package:

• Medical/Dental/Vision

• Paid Leave

• Paid Holidays

• Employee Assistance Program

• Retirement Plan, including employer matching

• Health Savings Account, including employer matching

• Professional Development Allowance up to $1500 per year

• Bilingual Stipend up to 6% of the base salary

• Many other benefits

Equal Employment Opportunity/Affirmative Action Employer

Tobacco-Free Facilities - Metrocare is committed to promoting, the health, well-being, and safety of Metrocare team members, guests, and individuals and families we serves while on the facility campuses. Therefore, Metrocare facilities and grounds are tobacco-free.

No Recruitment Agencies Please

Qualifications