Revenue Cycle Manager

SUMMARY OF RESPONSIBILITIES The Client Manager is responsible for managing the revenue cycle processes for physician practices and ambulatory surgical centers. The Client Manager will analyze the financial health on a monthly basis to identify reimbursement trends, patterns of denials, and develop an intimate understanding of the factors that are contributing to the financial performance. ESSENTIAL FUNCTIONS The Client Manager is responsible for the coordination of the Revenue Cycle Department, which includes billing and collection activities. Responsible for overseeing eligibility, pre-authorization, time of service collections of co-pays and deductibles, coding of services, and reporting. Reviews, revises, and/or implements policies and procedures within the department to ensure that best practices are followed in both the billing and collections functions, while remaining in compliance with federal/state laws, rules, and regulations as well as third party contracts. Oversight of charge entry, claim submission, payment posting, denials management, bad debt and collections, appeals processing, credit balance resolution, and accounts receivable management. This includes being responsible for monitoring the productivity of all staff members- in person and those who work remotely. Generates billing and collections data that supports finance and business operations and produces pricing and coding feedback that will optimize reimbursement. Provides strategic guidance and analysis of the revenue cycle service line. Reviews, designs, and implements processes surrounding third party payer relationships, collections, and other financial analyses to ensure clinical revenue cycle is effective and properly utilized. Ensures all billing and collection practices are appropriate and align with payer policies and guidelines. Identifies payer trends and reimbursement issues that can negatively impact the revenue cycle. Utilizes data analysis, report writing and electronic data retrieval skills to extract, compile and present clear and concise information. Maintains an understanding of coding rules and guidelines; utilizes coding and claims processing knowledge and resources to identify possible risks and revenue opportunities related to coding. Collaborates with the Company’s external CPAs and Chief Legal Officer to ensure compliance with regulatory requirements. Identify and correct workflow issues to help optimize revenue. Works with Director of Practice Management and ASC Administrator regarding any front desk or clinical workflow issues that may impede revenue cycle. Works with collection vendors on accounts that are deemed delinquent. Monitors A/R to include oversight of days in A/R, gross billings, gross collections, net revenue, percent of collections to net revenue, monitoring and management of denial rates and denial categories related to activity. Develop metrics and benchmarks for billing and accounts receivable. Oversees and directs the creation and continual improvement of departmental procedures and best practice tools for billing, reimbursement, and collections. Responsible for departmental specific training of employees; planning, assigning, and directing work; appraising performance; disciplining employees; addressing complaints and resolving problems. Adheres to professional standards, company policies and procedures, and federal, state, and local laws and regulations. Works to reduce charge holding, rejections, missing information, and denials reports. Prepares billing reports summarizing billings, adjustments, and revenues received. Evaluates clients billing needs. Responsible for creating and educating clients on best practice workflow. Responsible for data base setup content in the software to ensure best billing practices workflow. Responsible for coordinating all practice billing activities with physician practice and RCM billing teams. Works closely with the Implementation Team assigned to ensure proper system build and billing set up. Responsible for processing clearing house enrollment and assisting the physician practice to set up EFTs as desired. Ensures that the client’s system is set up correctly and trains staff on PrognoCIS software based on their workflow using billing best practices. Responsible for daily tracking of operational elements of physician practice to include encounters (open/closed), timely claims processing, accurate payment posting, monitoring of un-posted payments, billing questions, clearinghouse reports, weekly go-live follow up. Establishes and maintains working relationships with physician practice. Makes workflow recommendations to both customer and internal RCM team to improve back-office operation. Responsible for denial management process and reporting for assigned practices. Responsible for accounts receivable process and reporting for assigned practices. Creates Month End Reporting and submission to provider practices. Responsible for researching, documenting, and training billing teams on specific insurance, coding, and documentation requirements. Responsible for researching and sharing billing information pertinent to States and Insurances. Requirements CORE COMPETENCIES Excellent oral, written, interpersonal, communication and presentation skills. Ability to communicate effectively in a variety of settings and with a wide variety of people and different organization levels. Highly organized with the desire and ability to effectively track projects from start to finish. Must be able to manage multiple projects simultaneously. Ability to work in a team environment as well as independently and with little to no supervision. Demonstrate consistent reliability, integrity, and dependability. Setting and achieving high goals and standards of performance. Strong eye for detail, accurately inputting data. Knowledge of Medicare, Medicaid, commercial paper and electronic claims processing. Knowledge of ICD, CPT, HCPC coding, ability to read EOBs, familiarity with HIPAA rules. REQUIRED EDUCATION, EXPERIENCE, AND/OR CERTIFICATIONS • Minimum 3-5 years medical billing experience. • Certified Professional Coder. • Family Practice experience required. • Pain Management Experience is a plus. • ASC billing is a plus. • Experience in eligibility verification, ERA, familiarity with HIPAA rules. • Knowledge of billing workflow. • Ability to work in a fast-paced work environment. • Sound analytical and problem – solving skills. • Ability to make decisions and work independently. • Basic computer skills and familiarity with Microsoft Office Tools.