Revenue Cycle and Operations Manager

Job Description

Job Description

Company Overview

The Breastfeeding Shop is for mothers who need proper help, guidance, and accessories to help them with nursing their babies, The Breastfeeding Shop brings the best of all. We are a family-owned business and because we understand the joys and challenges of being a new mom, we have brought together a range of supplies for all mothers who choose to breastfeed or those who need access to a breast pump.

Role Overview:
The Breastfeeding Shop is seeking a Revenue Cycle and Operations Manager to own our order-to-cash operation end to end. Reporting directly to the CEO, you will take full accountability for four teams, processing, customer service, shipping, and billing, and for the revenue cycle that connects them. Making sure every mom who comes to us gets her supplies quickly, and that every order she places gets billed and paid correctly.

This is a leadership role. You will own the numbers, develop staff, and close the loop between what billing sees on the back end and what order intake processing does on the front end. We're looking for someone with deep-seated, hands-on experience across the full cycle from intake and eligibility through claim submission, denials, appeals, and AR. 

Key Responsibilities:

Manage and optimize the order-to-cash cycle

• Manage and optimize the order-to-cash cycle end to end - intake, insurance verification, order processing, shipment, claim submission, payment and patient balance - across processing, customer service, shipping and billing.
• Manage and optimize turnaround time and throughput at every stage; review queues daily, identify stuck and ageing orders, and determine and fix what's blocking them.

Billing and AR

• Manage and optimize billing accuracy and the clean-claim rate.
• Ensure resolution of every rejection, denial and appeal, and determine which denials are worth pursuing, and pursue them.
• Keep AR current by ensuring that all money owed to The Breastfeeding Shop by customers or insurances for goods or services delivered is paid on time : X% collected within 30 days, X% within 45 days. Own aging by bucket, credit balances, refunds and write-offs.
• Manage outsourced billing partners and lead the transition of outsourced work in house.

Payer expertise and the feedback loop

• Serve as the department's escalation point for complex eligibility, coordination of benefits, prior authorization, documentation and medical-necessity issues.
• Maintain current working knowledge of each payer's rules and update the team when they change.
• Turn denial and rejection data into recurring, specific education for the processing team so the same errors stop repeating.

Lead the team

• Lead 10 people across four functions. Develop and communicate position expectations to direct reports.  Have weekly one-on-one meetings with direct reports.  Coordinate a weekly stand-up meeting with teams and conduct annual performance reviews.
• Develop onboarding and ongoing training for all four functions; build cross-training so no function has a single point of failure.
• Audit a sample of each team member's completed work weekly; document findings, coach against them, address critical errors immediately.
• Balance workloads and coverage across the four functions.
• Assess staffing and role design; recommend headcount, role changes and team lead as volume requires.

Systems, process and reporting

• Create and/or update written SOPs for every role in the department and keep them current as payer rules and systems change.
• Strategize on process issues and improvements – present suggestions and collaborate with the systems team to implement them.
• Build repeatable reporting, defining KPI’s per role and department and keeping the team accountable.
• Responds to and completes commercial insurance audits as received.

Cross-functional and compliance

• Report weekly to executive leadership on performance, risks and learnings; escalate anything with monetary impact immediately.
• Collaborate with contracting so both teams stay abreast of payer developments, reimbursement patterns and denial trends.
• Maintain compliance with payer documentation requirements, audit response and HIPAA.

Requirements and Qualifications:

Required

• 5+ years in healthcare revenue cycle or medical billing, with hands-on ownership of denials, appeals and AR follow-up, doing the work, not overseeing a vendor doing it.
• DME experience, including documentation and medical-necessity requirements.
• Working knowledge of payer rules across commercial, Medicare, Medicaid and Tricare, and the ability to learn a new payer's requirements without handholding.
• 3-5 yrs. experience leading a team: training, workload balancing, holding people to a standard, performance conversations.
• Familiar with data, pulls and acts on denial and AR-aging. Strong Excel.
• Daily use of a CRM or billing platform as the system of record; Salesforce preferred.
• Working knowledge of HIPAA and payer audit response.
• Medical billing and coding certifications.

Preferred

• Breast pump or maternity DME.
• Experience transitioning outsourced billing in house and/or developing an in-house billing function.
• Writing and maintaining SOPs.
• Consideration made for remote workers.

The Breastfeeding Shop is an equal-opportunity employer.