Reporting to the Executive Director of Professional Billing Services, the Revenue Cycle Manager manages all aspects of revenue cycle activities including but not limited to: AR, coding, billing, reimbursement, compliance, collections, correspondence, patient refunds, education, data analysis, financial reporting and departmental administrative operations. The Revenue Cycle Manager is responsible for the analysis, design, development, and execution of revenue cycle initiatives related to improving revenue, improving cash collections, reducing cycle times, reducing avoidable write-offs, reducing costs, and increasing practice efficiencies. The Revenue Cycle Manager monitors and improves employee productivity, provides for ongoing improvements to key revenue cycle indicators, maximizes all aspects of the billing cycle, and creates strategies for increased revenue and cost savings. This position is also responsible for personnel development, initiating disciplinary action, implementing and maintaining relevant revenue cycle policies, and the continuous training of practice staff. The position requires exceptional organizational skills, follow-through and commitment to quality and best practices.
Responsible for the supervision of all Revenue Cycle staff including recruiting, training, evaluating and monitoring quality of work and productivity of the department. Establishes work schedules and ensures appropriate resources to complete work within established guidelines. Verifies and approves weekly payroll. Monitors and reviews hours worked for supervised staff as well as overall attendance patterns to ensure adequate staffing to meet revenue cycle requirements. Schedule and conduct staff meetings to facilitate attainment of both revenue cycle and employee goals and objectivities.
Manages daily administrative operations of the Revenue Cycle department including but not limited to reporting, contract agreements, credit card processing, equipment procurement, administrative operations, claims management, reimbursement and collections of accounts receivables and ensures timely, efficient claim correction and cash collection to support overall financial goals of the Practice. Monitors and manages activities of third party billing partner to ensure effectiveness of insurance billing and collection efforts.
Assists in the development, implementation and monitoring of key performance indicator metrics for areas of responsibility. Identifies trends and investigates discrepancies for needed corrective actions to assure financial obligations are met in areas of responsibility. Meet with staff, physicians, managers and administrators as needed to discuss and follow up on billing, coding, and revenue cycle.
Work collaboratively with eCW project team, third party billing vendor staff, practice administration, physicians and staff to define and implement best practices for eCW/EMR to ensure compliant, accurate billing. Utilizes the eCW Practice Management System to provide oversight of billing and processes related to the operation of the practice and analyze the performance of the practice, including scheduling, billing, claims, front office duties, and system reporting.
Responsible for administering an effective performance management program ensuring that departmental job descriptions are reflective of current responsibilities, defining and administering a career progression for staff seeking advancement, ensuring that performance management tools (e.g. metrics, review templates) are reflective of current responsibilities and performance standards, clearly communicating performance expectations to staff, completing and administering meaningful performance reviews on time, and issuing and monitoring corrective performance management plan as is appropriate and indicated up to and including termination for continued non-performance.
Develop and implement controls in assigned functional areas. Develop a consistent process for review of assigned functional areas. Ensure that all policies, processes, reports, schedules, and logs are properly maintained and issued as required.
Coordinates and administers the SHMG New Employee Orientation Program. Works collaboratively with HR and practice leadership to identify and implement ongoing enhancements and improvements to the program. Leads orientation classes as needed. Provides for the ongoing training of all practice staff as it impacts the Revenue Cycle.
Coordinates the comprehensive onboarding process related to the Revenue Cycle for new groups, physicians and mid-level providers joining SHIP in a timely fashion from due-diligence through post implementation phases of acquisition/employment.
Manage and monitor analysis process to identify discrepancies in contracted rates and takes necessary steps for corrective action to ensure appropriate reimbursement to the practice.
Facilitate the preparation of various revenue cycle status reports for management. Meet with physicians, managers, and administrators as needed to discuss billing, revenue cycle, contracting, and credentialing matters. Provides ad hoc analysis for strategic business questions related to Revenue Cycle.
Actively participate in planning and administration of Practice budget as assigned. Provide detailed projections and reports as required for development and management of departmental and practice wide budgets.
Assists Director and other practice leadership in the research, development, implementation maintenance of and compliance with practice policies, procedures, and guidelines related to coding, documentation, reimbursement, compliance and the overall revenue cycle.
Assists in conducting departmental meetings and communicates changes in policies, procedures and general tasks to supervised staff. . Participates on and provides committee support as needed. Leads or participates in cross-functional project teams when asked or indicated.
Analyzes data, identifies issues, reaches conclusions, and propose strategies for resolution of complex reimbursement issues.
Works with physicians, practice and third party billing partner staff to develop appeals to insurance carriers for medical necessity and other complex denials.
Maintain departmental compliance with all policies and procedures as outlined by the organization inclusive of external agency requirements. Ensure billing is performed in adherence with Practice’s compliance program, and participates on internal compliance committee as required providing for data analysis as needed.
Attend relevant seminars and professional association meetings to ensure compliance with professional standards. Establishes and maintains an active network of professional contacts.
Completes required continuous training and education, including department specific requirements.
Keeps informed regarding current regulations, insurance company policies, professional standards and company/department policies and procedures and effectively applies this knowledge.
Performs other related duties as assigned or requested in order to maintain a high level of service.
Bachelor’s Degree in Accounting, Healthcare Administration or equivalent and five years of professionally related experience in a physician practice setting; or an equivalent combination of education and experience required.
Minimum of one year in a supervisory role with demonstrated ability to provide employee performance and skill development feedback and guidance including performance evaluations, mentoring and performance improvement plans up to and including termination.
Proven experience and background in financial analysis and reporting is required.
Demonstrated experience with large billing and medical practice management systems, preferably eClinical Works (eCW).
High level of competency with computers, the Internet, and computer software such as MS Office or equivalent is required.
Considerable knowledge of medical office operations, professional fee billing, reimbursement and third party payer regulation and medical terminology is required.
Working knowledge of regulatory requirements pertaining to health care operations and their impact on practice operations.
Strong problem-solving skills and ability to make timely decisions in a fast-paced environment.
Ability to work, plan, research and conduct projects with minimal supervision.
Ability to organize and prioritize workload to manage multiple tasks and meet deadlines.
· Superior verbal, written, organizational, and interpersonal skills are required.
The ability to work with individuals at all organizational levels, particularly peers, team members, other departments, patients, and the community is required.