The Healthcare Financial Management Association (HFMA) defines revenue cycle as "All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue." ln other words, it is a term that includes the entire life of a patient account from creation to payment. Revenue cycle processes flow into and affect one another. When processes are executed correctly, the cycle performs predictably. However, problems early in the cycle can have significant ripple effects. The further an error travels through the revenue cycle, the more costly revenue recovery becomes.
Responsible for the improvement of utilization and other operational activities that support the overall objectives of MHHS. Will strive to continuously streamline operations, improve daily system usage and functionality.
The RCM will be responsible for overseeing the billing teams and all billing operation processes (i.e,
insurance eligibility processes, charge processing, claim submission/processing, payment processing,
collections and A/R, denial management, reporting results and analysis, concurrent and retrospective
auditing, proper coding, and insurance contract reviews). Oversee the day to day activities of the central
business office.
Health care revenue cycle management involves many strategies, including procedures that hospitals
and clinics use to improve cash collections and meet liquidity goals. These strategies also include
customer receivables valuation, underpayment recovery policies and transactions involving federal
government programs such as Medicare and Medicaid.
Oversee departments associated with revenue cycles, including billing, collections, health information management, etc. Work closely with CFO in monitoring, educating, management of staff. Review payors contracts, payments and reimbursement. Ongoing monitoring, Management of claims processing, payments and revenues. Utilizing technology as an essential tool for monitoring and educating staff, providers, patients and public.
compliance with CMS, Medicare, Medicaid, payors, etc. Sliding Fee and charity care programs.
adjudication, line item payment posting, electronic claim submission, clearinghouse set-up, and
intermediate knowledge of Excel with ability to utilize for data analysis. Understanding of basic Business Office functions to include patient registration and checkout, billing process via electronic and paper claim method, EOB interpretation and payment posting, denial tracking and denial resolution process,
all aspects of accounts receivable management.
Ambulance, etc. and/or business office leadership preferred.
management experience preferred.
desire the opportunity to lead a team environment.
deadlines and demonstrate the ability to think critically under pressure.
interfaces preferably with CPSI, NextGen, Therapy Source, and LTC software, Microsoft Word, Microsoft
Excel and Microsoft Outlook.
and Collection Practice Act, medical terminology, claims adjudication process and payer contract
familiarity.
executives
as an overall understanding of Medicare and other third party payers
care, CPT, ICD-9, 10 and HCPCS Coding
access and release information
and capabilities.
data.
business planning, strategy, problem solving, decision making and time management skills.
Ability to travel between sites includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
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0 Revenue Cycle Manager jobs found in Parkersburg, WV area