Medical billing: 1 year (Preferred)
Epic: 1 year (Preferred)
eClinicalWorks: 1 year (Preferred)
Subject: Revenue Cycle Operations Manager Job Description
Reports To: Director, Revenue Cycle Management
Working under the general direction of the Director, Revenue Cycle Management, the Revenue Cycle Operations Manager serves as the primary contact between designated clients and the Medcor team in all aspects relating to Revenue Cycle Operations. The position requires a self-starting, independent person with good client relationship skills who can effectively work and communicate closely with assigned client administration/ leadership and Medcor Senior Leadership. This role requires active participation with clients, acting as the active liaison able to proactively manage client accounts. This position requires a thorough understanding of billing practices of all processes that encompass the full revenue cycle. This includes experience with insurance billing, denials management and account resolution. The ideal candidate would also have some knowledge of EMR systems, clinical documentation, coding, compliance, auditing, analytics, patient access, and health information management. This includes a thorough understanding of systems, processes, and services specific to coding and billing requirements and would be responsible for proactively identifying opportunities for revenue cycle improvement opportunities. This position takes an active part in developing and executing identified opportunities/issues and providing healthcare clients with the status and analysis of standard operational, financial, billing and budget statistics. The Revenue Cycle Manager is accountable for ensuring the coordination of revenue cycle operations, procedures, and best practices for charge capture, billing, payment posting, collections and follow-up, denials management, billing audits, and revenue cycle data reporting for diverse clientele across regions. This position is responsible for overseeing a team of supervisors, leads, and medical biller teams.
A successful candidate will be responsible for driving the strategy and sustainability of each client and achieving maximum optimization and efficiency. This role requires current, in-depth knowledge of governmental and commercial insurance rules and regulations, including regulatory compliance requirements.
Essential Duties and Responsibilities:
1. OPERATIONAL OVERSIGHT:
a. Responsible for ensuring all RCM functions (billing, collections, payment posting, reporting and customer service) are operating efficiently and effectively.
b. Responsible for managing a team of RCM supervisors, leads, and medical billers. Understands the job functions of all Revenue Cycle staff, is aware of process flow across departments, and involves them, as appropriate, when recommended actions may impact their work functions.
c. Holds regular, weekly meetings with departmental supervisors and keeps them abreast of important issues related to revenue cycle operations.
d. Continually seeks ways and means for improving the delivery and support of revenue cycle activities and programs including monitoring the routine development of training material and ensuring educational resources to current and future staff.
e. Assists in the development and enforcing of policies and procedures for all points of the revenue cycle including, but not limited to, charge capture, data entry, payment posting, insurance follow up, collections and denials management.
f. Develops and implements evaluation tools and measures staff efficiency and effectiveness.
g. Creates an environment of continuous improvement and innovation.
h. Monitors and adheres to applicable Federal, State, and local laws and regulations, in congruence to The Medcor Group’s Inc.’s compliance and code of conduct, as well as other policies and procedures.
i. In collaboration with supervisors and leads, monitors the payments of third-party payers for assessing compliance with established contracts. Troubleshoots problems associated with missed or unbilled charges, payment delays, denials, and other revenue cycle issues.
2. KEY PERFORMANCE INDICATORS
a. Responsible for meeting or exceeding all RCM KPIs. Reviews KPIs daily and takes an active role in making appropriate adjustments to ensure goals are met.
b. Directs the maintenance of practice management systems master files for ensuring that the system is capable of efficiently managing the billing process.
c. Discusses performance data with senior management, Chairs, Supervisors, and others as necessary.
d. Develops methods for continually tracking and improving all facets of the RCM department, including but not limited to: denial trends by payer, monitoring insurance AR, monitoring percentage of money collected against charges billed, quality assurance reviews, reimbursement turnaround time, percentage of clean claims, days in receivable outstanding, staff productivity and performance ratios
3. REPORTING & ANALYSIS
a. Providing the analysis, reporting, recommendations and implementing strategic action plans for revenue cycle services performance in key metrics related to charging capture, billing, collections, and accounts receivable management, such as volumes, collection ratios, A/R aging, charge lag, and related trends to internal executive staff and clients, as applicable.
b. Assesses and responds to current and future internal and external healthcare trends to establish and ensure the necessary direction for revenue cycle activities
c. Participates in strategic planning, reporting and accountability.
d. Researches department, payer, provider and other specific issues associated with revenue cycle performance.
e. Provides ongoing comparisons of standard professional billing to rural health benefits, provider-based billing, federally qualified health clinic status and/or other reimbursement methods with the purpose of analyzing ongoing cost/benefit of these methods to help the organization select the optimal billing methodology.
4. CLIENT RELATIONS
a. Effectively manages client’s expectations regarding financial performance. Maintains ongoing issues and priority list for healthcare clients. Completes analysis of issues for action, presents this information and implements or supervises action plans. Prioritizes initiatives with clients or senior leadership on key performance issues. Proactively identifies sources of billing/denial issues and communicates these to the appropriate parties.
b. Responsible for providing exceptional customer service to our clients, associated vendors, and other internal customers (RCM, Finance, etc.).
c. Knows, understands, incorporates, and demonstrates The Medcor Group, Inc.’s Mission, Vision, and Values in behaviors, practices, and decisions.
d. Develops a world-class team to ensure excellent service to our partners and efficient, effective operations, including time and resource management.
e. Partners with, and maintains positive relationships with all clients, and can professionally and autonomously represent The Medcor Group, Inc. during client meetings.
f. Participate as an integral member of the acquisition/transition team.
g. Acts as a resource to assist client departments in revenue cycle performance.
h. Presents a positive and professional image at all times.
i. Performs other duties as assigned and necessary.
Knowledge, Skills and Abilities:
1. Bachelor’s degree or higher in business, health care administration or related field is highly preferred, but experience can be substituted for education.
2. Excellent communication and collaboration skills across a range of stakeholders.
3. Minimum 5 years of revenue cycle experience with progressive responsibility managing several revenue cycle functions.
4. Experience with practice management systems such as eClinicalWorks, NextGen, Epic, etc.
5. Knowledge of Managed Care, Third Party Payer, and Medicare Regulations.
6. Prior experience leading various areas of revenue cycle (charge capture, coding, billing, collections, denials, etc.) with proven success in achieving revenue cycle efficiencies and improving cash flow.
7. Experience with data analysis in the healthcare industry.
8. Experience working closely and communicating directly with physicians, and executives.
9. Must have the ability to handle multiple tasks and work with various tight deadlines.
10. Requires excellent oral and written communications skills
11. Demonstrated interpersonal skills to work with physicians, patients, and staff at all levels must have the ability to relate to people in a manner to win confidence and establish rapport.
12. Knowledge of HIPAA and other applicable state/federal requirements.
1. Moderate to advanced computer skills including Word and Excel, ability to autonomously generate reports and navigate complex pivot tables
2. Internet navigation and research best practices
3. EMR/EHR software experience, experience with multiple EMR/EHR platforms required
4. Proficiency in Microsoft Office suite (Excel, Word, Access, and Outlook) required
5. Ability to type 30 correct words per minute
6. Ability to operate a personal computer, related software, and others standard office equipment
1. Sitting for long periods of time.
2. Move quickly when client or patient needs assistance
3. Using keyboard
4. Using telephone receiver
1. Involves frequent telephone calls with patients. Line must be clear of personal business so patients can get through.
2. Work may be stressful at times. Interaction with others is constant and interruptive.
3. Well-lit, ventilated workspace.
4. Occasional travel maybe required
Equal Employment Opportunity
The MEDCOR Group, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Job Type: Full-time
Pay: $34.00 - $44.00 per hour
Masks are provided to all employees and the workplace is sanitized on a daily basis. Internal COVID procedure included.
Work Location: One location