Description
The Revenue Cycle Manager will be responsible for managing billing operations, optimizing revenue collection, and ensuring compliance with billing regulations and payer requirements. This position is a Hybrid position, requiring a combination of on-site and remote work to effectively support operational needs. The ideal candidate will have strong leadership skills, expertise in revenue cycle management, and a commitment to maximizing revenue while maintaining high standards of integrity and compliance.
Responsibilities:
Billing Operations Management:
Oversee all aspects of billing operations, including charge entry, claims submission, payment posting, and accounts receivable management. Monitor billing processes and workflows to ensure accuracy, efficiency, and compliance with billing regulations and payer requirements.
Revenue Cycle Analysis and Optimization:
Analyze revenue cycle metrics, key performance indicators (KPIs), and financial reports to identify trends, patterns, and areas for improvement. Develop and implement strategies to optimize revenue collection, reduce denials, and increase cash flow.
Claims Processing and Denial Management:
Manage claims processing activities, including timely submission of clean claims and resolution of claim rejections and denials. Conduct root cause analysis of claim denials, identify trends, and implement corrective actions to prevent future denials.
Accounts Receivable Management:
Monitor accounts receivable aging reports, analyze outstanding balances, and follow up on unpaid claims and patient balances. Implement strategies to reduce accounts receivable days, improve collections, and minimize bad debt write-offs.
Payer Relations and Contract Management:
Maintain relationships with payers, insurance carriers, and third-party billing vendors to ensure accurate reimbursement and compliance with payer contracts. Negotiate payer contracts, fee schedules, and reimbursement rates to optimize revenue and minimize payment discrepancies.
Compliance and Regulatory Requirements:
Ensure compliance with billing regulations, coding guidelines, and payer policies, including HIPAA regulations and CMS guidelines. Stay informed about changes in healthcare regulations, reimbursement policies, and coding updates affecting the revenue cycle process.
Staff Training and Development:
Train and mentor revenue cycle staff on billing best practices, coding guidelines, payer requirements, and revenue cycle workflows. Provide ongoing education and support to staff to enhance their skills and performance.
Requirements
Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field required; Master's degree preferred.
Minimum of 5-7 years of experience in revenue cycle management, medical billing, or healthcare finance, preferably in a medical practice or healthcare organization.
Strong leadership and management skills, with the ability to motivate and inspire staff to achieve revenue cycle goals and objectives.
Expertise in healthcare billing and coding regulations, payer reimbursement methodologies, and revenue cycle processes.
Proficiency in using revenue cycle management software, billing systems, and electronic health records (EHR) systems.
Knowledge of healthcare compliance regulations, including HIPAA, CMS guidelines, and payer policies.
Excellent analytical skills, with the ability to analyze data, identify trends, and implement strategies to optimize revenue.
Strong communication and interpersonal skills, with the ability to interact effectively with staff, physicians, payers, and external stakeholders.