Revenue Cycle Manager

Job Description

Job Description

SUMMARY

The Revenue Cycle Manager is responsible for leading all revenue cycle operations, including behavioral health billing, contract billing, accounts receivable management, payer follow-up, denial management, education funding programs, credentialing support, and revenue cycle analytics. This position ensures timely, accurate reimbursement while maintaining compliance with Ohio Medicaid, Managed Care Organizations (MCOs), and all regulatory requirements. The Revenue Cycle Manager supervises Billing Specialists and partners closely with Clinical Operations, Finance, and Utilization Management to maximize reimbursement and reduce revenue leakage.

ESSENTIAL DUTIES & RESPONSIBILITIES

General:

• Contributes to creating a welcoming and inclusive environment for our clients, colleagues and community partners from diverse backgrounds and experiences.
• Integrates principles of Trauma Informed Care in all aspects of work.
• Is sensitive to the children’s culture and socioeconomic characteristics that delivers the best possible care to the youth and families served.
• Contributes to creating a welcoming and inclusive environment for our clients, colleagues and community partners from diverse backgrounds and experiences.
• Is sensitive to the children’s culture and socioeconomic characteristics that delivers the best possible care to the youth and families served.
• Promotes collaboration between Finance and Clinical Operations.
• Supports continuous process improvement initiatives.
• Maintains confidentiality in accordance with HIPAA.
• Participates in performance improvement activities.

Revenue Cycle Operations:

• Oversees all behavioral health billing operations.
• Oversees contract billing. (non-medical billings).
• Oversees school-based and educational funding billing.
• Ensures claims are submitted accurately and within payer timelines.
• Monitors daily billing queues.
• Reviews claim edits before submission.
• Coordinates timely claim corrections.
• Oversees aging accounts receivable.
• Establishes collection priorities.
• Reduces aged receivables.
• Escalates payer issues.
• Monitors payment trends.
• Resolves reimbursement barriers.
• Creates various billing reports for month-end close and financial reporting
• Oversees denial management process.
• Identifies root causes of denials.
• Implements corrective actions.
• Tracks denial trends by payer.
• Coordinates appeals.
• Ensures billing complies with Ohio Medicaid regulations.
• Validates documentation supports billed services.
• Identifies missed billing opportunities.
• Performs internal billing audits.
• Coordinates payer audits.
• Assists with the collection of data (deposits and payments) for schedules and reports used in the preparation of daily cash flow management and for month-end close.
• Supports CFO and Controller with accounting reports, financial analysis, and ad-hoc reporting as assigned.
• Assists with preparation and completion of the year-end audit.
• General office duties, including filing, copying, scanning, and customer service.
• Preforms accounting tasks that support the successful execution of the agency’s accounting needs.
• Knowledge of processing NPI numbers to ensure accurate billing and claims processing.
• Other duties as assigned or requested

EDUCATION &/OR EXPERIENCE

• Bachelor's degree in Healthcare Administration, Business Administration, Accounting, Finance, or a related field preferred.
• An equivalent combination of education and progressively responsible healthcare revenue cycle experience may be substituted.

• 3+ years of healthcare revenue cycle management
• Behavioral health billing experience preferred
• Ohio Medicaid and MCO knowledge
• Claims, denials, AR, and reimbursement expertise

Language Skills: Ability to communicate and work effectively, both orally and in writing. Thorough knowledge of English grammar and spelling, effective communication skills, and familiarity with standard office procedures required. Strong interpersonal skills are essential

Mathematical Skills: Ability to deal with a high volume of numbers and data in an accurate manner. Ability to read, analyze and interpret complex financial reports & data. Ability to work with advanced mathematical concepts and to apply such concepts to practical situations. Ability to define problems, collect data, establish facts, draw valid conclusions, and make sound recommendations.

Technical Skills : Strong computer skills to include proficiency with Microsoft Office Suite (i.e. MS Word, Excel and Access). The ability to research and analyze various different types of data information. Ability to use standard office equipment such as copy/fax machines and printers.

Reasoning Ability: Ability to prioritize and complete tasks with minimal supervision and demonstrate excellent organizational skills. Strong analytical and problem-solving skills. Must have the ability to make recommendations to effectively resolve problems or issues, by using judgment that is consistent with standards, practices, policies, procedures, regulation, or government law. Ability to multi-task, prioritize and to meet critical deadlines on a continuing basis. Ability to work cooperatively and collaboratively with others in order to achieve expected outcomes.