SUMMARY: The Revenue Cycle Manager manages all functions of the organization’s billing and revenue cycle to maximize cash flow while maintaining and improving internal and external customer relations. This position will work directly with our Billing Department and contribute to the day-to-day operations on all issues related to the revenue cycle function, provide analysis, create written processes, and train others in implementing a cross-functional revenue cycle team. The Revenue Cycle Manager provides oversight, guidance, and direction over revenue cycle operations for Southwest and will develop and implement strategies that maximize the efficacy and efficiency of these operations.
SPECIFIC DUTIES AND RESPONSIBILITIES: All duties are subject to accommodation in accordance with the Americans with Disabilities Act (ADA)
- Oversees revenue cycle operations such as account management, communications with insurance providers, collections, cash posting, contract analysis and billing to ensure the successful management of receivables and effective and efficient function of the revenue cycle.
- Implements a system to ensure that accurate billing information is entered into the billing system.
- Implements revenue cycle management strategies to maximize collections.
- Analyzes data and creates reports for management to analyze trends and make recommendations.
- Identifies lost revenue.
- Manages patient complaints with outsourced billing company.
- Monitors charges, gross and net collections ratios, accounts receivables.
- Assists in the determination of a potential need for an update to the fee schedule on at least an annual basis.
- Coordinates with Provider Credentialing manager to stay current on credentialing issues, especially in the case of new providers.
- Monitors coding practices among providers to determine potential patterns of under coding and other irregularities.
- Establishes and maintains a regular process for follow up on patient accounts which are pending approval for third party coverage.
- Manages the relationship with the Practice Management company.
- Maintains current knowledge of all applicable laws and regulations, ensuring operations maintain necessary compliance.
- Facilitates communication and coordination with cross-divisional teams, customers, vendors and/or third parties to ensure the effective exchange of necessary information.
- Provides appropriate training for the team to ensure the maximum efficacy and efficiency of operations.
- Other related duties as assigned.
Qualifications:
- Knowledge of professional fee billing, reimbursement, and third-party payer behavior.
- Strong data analysis and computer skills with proficiency in MS Office and Google Suite.
- Demonstrated proficiency with Practice Management Systems, preferably the EPIC system.
- Detailed oriented with strong analytical and organizational skills.
- Working knowledge of regulatory requirements pertaining to health care operations and their impact on operations.
- Sound knowledge of health insurance providers.
- The ability to work in a fast-changing business environment.
- Strong management skills with the ability to lead cohesive and productive teams.
- Strong interpersonal skills with the ability to communicate with all levels of management.
- Excellent verbal and written communication skills.
Education and/or Experience:
Bachelor’s Degree in finance, business administration, healthcare administration, or related field required; Master’s Degree in business preferred. At least 5 years of medical billing experience or related revenue cycle management experience. Coding and documentation experience preferred.
Physical Requirements and Work Environment:
The physical requirements and work environment 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. This position requires the manual dexterity sufficient to operate phones, computers, and other office equipment. The position requires the physical ability to kneel, bend and perform light lifting. This person must have the ability to write and speak clearly using the English language to convey information and be able to hear at normal speaking levels both in person and over the telephone. Specific vision abilities required by this job include close vision, depth perception and the ability to adjust focus. Generally, the working conditions are good with little or no exposure to extremes in health, safety hazards and/or hazardous materials. This person must have the ability to travel as required to work with staff.