Revenue Cycle Manager

Job Description

Job Description

Revenue Cycle Manager

JOB SUMMARY

The Revenue Cycle Manager oversees assigned revenue cycle operations, including billing, claims submission, payment posting, collections, accounts receivable follow-up, payer enrollment, and payments to contracted facilities and consulting physicians. This role monitors and reports key performance indicators, including days in accounts receivable, clean claim rate, denial rate, net collection rate, aging balances, and cash collections; identifies trends; and implements process improvements to support accurate, timely reimbursement. The Revenue Cycle Manager plans, directs, supervises, and supports staff responsible for patient financial services and works collaboratively with departmental and agency staff, contracted providers, payers, and the Director of Revenue Cycle to resolve billing, collections, credentialing, enrollment, reimbursement, and compliance issues.

PRIMARY JOB DUTIES

1. Oversees, assigns, regulates, and verifies the accuracy of all activities within the patient financial services division to include patient account billing, verification of benefits and coverage for all patients, daily census information, statistical reporting requirements and general ledger and financial reporting.

2. Plans, directs, supervises, and performs collections of patient accounts receivable balances using appropriate actions and tools. Works collaboratively with departmental and agency staff to assist with collections and claims resolution to ensure collections of patient account balances. Identifies and develops measurement standards for the monitoring of balances and assessment of the operational effectiveness of collection activities.

3. Supervises division staff in accordance with agency policy and procedure. Responsibilities include training employees, planning, assigning, and directing work; appraising performance, rewarding, and disciplining employees; addressing complaints and resolving problems.

4. Obtains and maintains expert-level knowledge of Netsmart, Epic, and other revenue cycle, billing, reporting, and productivity systems used to support eligibility verification, claims submission, collections, accounts receivable follow-up, payer enrollment, reporting, and workflow management for the assigned division.

5. Oversees and regulates all communications with contracted agencies and consulting physicians, as related to billing and collections, to ensure accurate and timely flow of billing information and payments.

6. Completes, submits, tracks, and maintains initial and ongoing payer enrollment, credentialing, and recredentialing applications and supporting documentation to support timely billing and reimbursement.

7. Collaborates with clinical, finance, information technology, and operational teams to support accurate documentation, eligibility verification, charge capture, billing, claims submission, reimbursement, account follow-up, and revenue integrity. Serves as a resource for resolving complex billing, payer, coding, documentation, and reimbursement issues.

8. Organizes and performs work effectively and efficiently.

9. Maintains and adjusts schedule to enhance program performance and meet deadlines.

10. Demonstrates positive interpersonal relations in dealing with all members of the team.

11. Maintains and promotes customer satisfaction.

12. Effectively demonstrates the mission, vision, and values of Lower Cape Fear LifeCare daily.

JOB SPECIFICATIONS

1. Education: High School Diploma or GED required. Bachelor’s degree in business, accounting, healthcare administration, finance, or related field preferred; equivalent combination of education and directly related revenue cycle experience may be considered.

2. Licensure / Certifications: CHAA, CHAM, or other healthcare revenue cycle, billing, coding, or health information certification preferred.

3. Experience: Minimum of 3 years of healthcare billing, collections, accounts receivable, payer follow-up, denial management, or revenue cycle experience required; supervisory or lead experience preferred. Knowledge of Medicare, Medicaid, and commercial payer billing requirements required. Hospice and palliative care revenue cycle management experience preferred.

4. Essential Technical / Motor Skills: Proficient with Microsoft Office, especially Excel, and able to use revenue cycle, electronic medical record, billing, reporting, payer portal, and workflow management systems. Experience with Netsmart, Epic, or other EMR and billing platforms preferred.

5. Interpersonal Skills: Excellent interpersonal, teamwork, leadership, customer service, and written and verbal communication skills required for working effectively with agency staff, leadership, contracted providers, payers, patients, families, and other external contacts.

6. Essential Physical Requirements: Long periods of sitting or standing, walking, lifting, and carrying files and supplies, reaching, stooping, long periods of data entry/file updates.

7. Essential Mental Abilities: Strong prioritization, organization, analytical, problem-solving, and reasoning skills required. Ability to concentrate while managing high volumes of work, meet deadlines under pressure, exercise good judgment, follow procedures, work independently, respond to frequent interruptions, and identify trends or issues that affect billing, collections, reimbursement, and operational performance.

8. Essential Sensory Requirements: Visual acuity, touch, hearing.

9. Exposure to Hazards: Office environment, toner for office machines, high pitch of printers, screen glare.

10. Other - Hours of Work: Occasional need for flexible hours to meet system scheduling needs of staff and agency.

11. Population Served: Internal and external personnel.