Revenue Cycle Manager

Job Description

Job Description

Position Overview: The Revenue Cycle Manager is a pivotal role within Chicago Center for Sports Medicine & Orthopedic Surgery, responsible for overseeing all aspects of the revenue cycle process. This role encompasses the management and collection of patient service revenue, ensuring administrative and clinical functions are optimized for the capture, management, and collection of all patient revenues. The ideal candidate will maintain a predictable performance cycle and swiftly address any discrepancies or errors to minimize their impact and avoid potential revenue recovery costs.

Key Responsibilities:

• Oversee the entirety of the revenue cycle billing operations to maintain a full and efficient revenue stream.
• Lead and assess the billing/front desk department's activities, including patient demographic entry, payment collections, and deposit management.
• Conduct daily management of staff, including organizing monthly meetings to discuss communication improvements, address concerns, and strategize on productivity enhancements.
• Generate and analyze end-of-month reports for review with the medical team to ensure accountability and proper authorization (Aging, claims, revenue posting).
• Audit received payments for accuracy against contracted reimbursement rates and oversee tasks and procedures related to AR reduction.
• Maintain accounts receivable with the objective of securing payment on denials within 90 days.
• Supervise the preparation of A/R appeals, manage aged accounts, and delegate workflows for the billing department.
• Execute collection protocols, including the dispatch of collection letters and monthly communication with delinquent accounts.
• Stay abreast of industry changes to minimize denials and introduce new appeal strategies.
• Manage the billing department's daily operations, including claim submission, ensuring all billing is processed and completed daily.
• Oversee significant payer accounts and manage transactions with other commercial insurances.
• Maintain meticulous record-keeping of contracts with insurance companies and stay current on coding guidelines by engaging with continuing education resources.
• Coordinate office functions focusing on computerized scheduling, electronic billing, reimbursements, collections, accounts payable/receivable, and data management.
• Implement Continuous Quality Improvement (CQI) guidelines to evaluate business operations, prepare financial reports, and manage all internal credentialing procedures.
• Act as the primary contact and liaison for patients, staff, providers, and technicians to ensure efficient communication and problem resolution.

Reporting Responsibilities:

• Manage and audit various reports, including daily, weekly, and monthly billing and A/R reports.
• Monitor gel injections and other buy-and-bill items for revenue capture, inventory management, and payment review.
• Ensure monthly submission of settlement and IME spreadsheets.
• Maintain oversight of patient collections, pre-registration processes, registration data collection, remittance processing, and third-party follow-ups.
• Conduct utilization reviews to evaluate the necessity and efficiency of medical services and facilities.

Summary of Responsibilities for Practice Administrator/COO Review:

• Provide a comprehensive overview of financial performance, including patient counts, insurance transactions, collection accounts, and overall aging.
• Conduct insurance audits to ensure accurate CPT and ICD-10 coding, evaluate managed care contracts, and perform reimbursement analyses.
• Offer provider training to ensure accurate and complete clinical documentation for maximum reimbursement.
• Evaluate clinical templating for adherence to documentation guidelines and the full utilization of ECW templates.

Qualifications:

• Proven experience in revenue cycle management within a medical practice setting.
• Strong understanding of medical billing, coding, and reimbursement processes.
• Excellent leadership and organizational skills with the ability to manage multiple priorities.
• Proficient in medical billing software and technology.

The Revenue Cycle Manager at Chicago Center for Sports Medicine & Orthopedic Surgery is integral to our practice's financial health. You will ensure that our practice thrives by effectively managing the revenue cycle and upholding the highest standards of financial and operational excellence.