Billing Office Manger

Job Description

Job Description

Salary:

Job Title: Revenue Cycle Manager

Job Summary: As the Revenue Cycle Manager at Peak ENT Associates, you will play a crucial role in overseeing and managing the smooth and timely workflows of coding, billing, and collections functions to ensure that our practice maintains smooth cash flow and a high level of operational and regulatory excellence. The successful candidate will possess a bachelor's degree or higher, along with significant experience in healthcare revenue cycle billing, coding, payer, and compliance.

Key Responsibilities:

1. Revenue Cycle Oversight: Direct and oversee all revenue cycle activities, including patient registration, insurance verification, coding, billing, timely claims processing, collections, and accounts receivable management.
2. Performance Monitoring: Monitor key performance indicators (KPIs) related to revenue cycle metrics, such as clean claim rates, days in accounts receivable, denial rates, and revenue collection, and implement strategies to optimize performance and achieve financial goals.
3. Process Improvement: Continuously evaluate revenue cycle processes and identify opportunities for improvement, efficiency gains, and cost savings. Develop and implement initiatives to streamline workflows, reduce denials, and enhance revenue capture.
4. Compliance: Ensure compliance with all relevant healthcare regulations, including HIPAA, Medicare, and Medicaid guidelines, as well as coding and billing standards. Stay abreast of regulatory changes and industry best practices to maintain compliance and mitigate risks.
5. Team Leadership: Provide leadership, guidance, and mentorship to the revenue cycle team, including billing specialists, coders, and revenue cycle coordinators. Foster a culture of accountability, collaboration, and professional development.
6. Vendor Management: Collaborate with external vendors, such as collection agencies and revenue cycle software providers, to optimize services, resolve issues, and ensure alignment with organizational goals and objectives.
7. Financial Analysis: Conduct financial analysis and reporting related to revenue cycle performance, trends, and projections. Prepare regular reports and presentations for senior leadership to inform strategic decision-making.

1. Customer Service: Maintain a high standard of customer service excellence in all revenue cycle interactions, both internal and external. Address patient inquiries, concerns, and complaints related to billing and financial matters promptly and professionally.

Qualifications:

• Bachelor's degree in healthcare administration, business administration, finance, or related field (Master's degree preferred).
• Minimum of 5 years of progressive experience in revenue cycle management within a healthcare setting, preferably in otolaryngology or a related specialty.
• In-depth knowledge of healthcare billing and reimbursement processes, including CPT, ICD-10, HCPCS coding, and third-party payer regulations.
• Strong understanding of revenue cycle software systems, electronic health records (EHR), and practice management systems.
• Proven leadership and management skills, with the ability to motivate and develop a high-performing team.
• Excellent analytical, problem-solving, and decision-making abilities.
• Exceptional communication, interpersonal, and customer service skills.
• Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) certification preferred.

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Signature Date

Behavioral Interview Questions

1. Tell me about a time when you identified inefficiencies in the revenue cycle process. What steps did you take to address them, and what was the outcome?
2. Describe a situation where you had to lead a team through a challenging period of high denial rates. How did you approach the problem, and what strategies did you implement to improve performance?
3. Can you share an example of a time when you successfully implemented a new revenue cycle software system or technology? How did you ensure a smooth transition, and what were the key factors that contributed to its success?
4. Give me an example of a difficult conversation you had with a team member who was consistently underperforming in their role. How did you address the issue, and what steps did you take to support their improvement?
5. Describe a situation where you had to navigate a complex billing dispute with a third-party payer. How did you approach the negotiation process, and what strategies did you use to reach a resolution?
6. Tell me about a time when you had to balance the need for revenue generation with maintaining compliance with healthcare regulations. How did you ensure that revenue cycle processes were both efficient and compliant?
7. Can you give an example of a time when you had to handle a particularly challenging patient billing issue? How did you communicate with the patient to resolve the issue and maintain a positive patient experience?
8. Describe a project you initiated to improve revenue cycle performance metrics, such as days in accounts receivable or denial rates. How did you measure the success of the project, and what lessons did you learn from the experience?
9. Tell me about a time when you had to work closely with external vendors or partners to address a revenue cycle challenge. How did you manage the relationship, and what strategies did you use to ensure effective collaboration?
10. Give me an example of a time when you had to adapt quickly to changes in healthcare regulations or payer policies. How did you stay informed about the changes, and how did you ensure that your team remained compliant?

Revenue Cycle Manager Service Level Definitions:

1. Revenue Cycle Oversight:
   • Ensure clean and timely claims are sent to payers. No later than 2 business days.
   • Ensure all high dollar accounts are properly maintained and worked. Each account >$5,000 total balance will be worked every 30 days.
   • Provide monthly reports to each doctor including, by the 10th of the month. (Build and test in November 2024, begin pilot reporting in December 2024)
     • Outstanding Accounts Receivable
     • Write-Offs
     • Collection Accounts
     • Charges, Payments, Adjustments
   • Ensure all cash controls are in place and monies are deposited securely each day.
2. Performance Monitoring:
   • Create KPIs / production expectations by position.
   • Create reports and automate production data wherever possible, where not possible, require individual reporting provided daily or weekly.
3. Financial Analysis:
   • Provide feedback on bundling, pre-auth, or other denial trends that could help increase revenue. For example, should we be doing a procedure in another POS, using a modifier, etc.
4. Customer Service:
   • Responds to external email within 1 business day.
   • Answers the phones within 30 seconds.
   • Responds to texts within 2 hours.