On Site - Revenue Cycle Manager

Job Description

Job Description

Benefits:

• Health insurance
• Paid time off
• Vision insurance
• 401(k)
• 401(k) matching
• Dental insurance

Position Summary:

This position oversees the entire revenue cycle from claims processing and clearinghouse operations to A/R management, payer relations, compliance, and staff development. The Revenue Cycle Manager collaborates closely with clinical, operational, and administrative leadership to ensure timely and accurate billing, maximize reimbursement, and uphold high standards of compliance and service. 

Essential Duties and Responsibilities:

• Provides training and support for billing staff, credentialing team, providers and clinic managers.
• Provides leadership and supervision to the following positions: Billing Supervisor and Credentialing Coordinator.
• Collaborates with Front Office Supervisors/Manager regarding policies and procedures that affect the revenue cycle.
• Works with the accounting team to ensure proper recording of patient revenue and related statistical data and analyzes and monitors billing trends.
• Performs regular of agency billing practices, recommends and implements changes to policies and procedures as necessary.
• Update and maintain the monthly RCM Dashboard and present monthly data to CFO.
• Identify and implement a quality improvement initiative annually.
• Maintain fee schedule for each service area.
• Develop and implement policies and procedures to improve workflow efficiency and revenue integrity.
• Serve as a point of contact for escalated patient billing concerns and payer issues.
• Open cases with Practice Management vendor to troubleshoot and resolve issues as needed.
• Attend internal and external meetings that pertain to Billing.
• Continuously monitor Outstanding AR and address areas of concern.
• Analyze and monitor Denial trends amongst various payers.
• Analyze claims data and suggest/implement procedures to maximize HEDIS and incentive revenue collections (i.e., level II HCPCS codes, ICD-10 and CPT modifiers).
• Perform billing analysis to ensure that the Billing Department is maximizing cash receipts.
• Communicates issues that are preventing timely and accurate billings to CFO for performance improvement process.
• Partner with managers to establish, implement, and refine front office protocols that support efficient revenue cycle operations
• Ensure timely monthly close of the billing function.
• Prepare and distribute end-of-month management reports.
• Assist CFO with annual PA Medicaid cost reporting, audits, Medicare cost reports, HRSA reports/compliance/site visits, UDS, and other regulatory entities.
• Reviews contracts to ensure contract fees are entered correctly, and routinely audits receipts to ensure payor compliance with contract terms
• Supervise day-to-day revenue cycle operations, including charge capture, claim submission, denials management, payment posting, and patient collections.
• Monitor key performance indicators (KPIs) such as days in A/R, denial rates, and collection percentages; identify trends and implement corrective actions.
• Ensure compliance with all FQHC billing regulations, including Medicare, Medicaid, sliding fee schedules, and managed care requirements.
• Review claims for accuracy and completeness prior to submission; oversee resolution of rejected or denied claims in a timely manner.
• Coordinates Sliding Fee Discount Program.
• Manage the configuration of all electronic billing systems to ensure proper functioning for effective and efficient billing and collection processes.
• Establishes and maintains effective working relationships with external vendors, service providers, and internal finance staff to ensure accurate billing, timely claims processing, and efficient financial operations.
• Serves as the primary liaison to resolve billing discrepancies, coordinate contract terms, and implement process improvements in partnership with the finance department.
• Provide support and training to practitioners to ensure accurate, timely filing of claims
• Ensure the timely submission of all claims for payment to third party payers.
• Develop, implement and oversee procedures for the review, appeal and resubmission of all claim denials.
• Manage the reconciliation of all discrepancies found in billing records in a timely manner, and provide reports to management or outside entities, as appropriate
• Develop, implement and oversee procedures for the posting of all third-party payments received and the reconciliation of identified differences
• Conduct quality assurance and accuracy audits of patient accounts
• Must have the ability to work and travel between locations as needed.
• Performs other duties as assigned by the CFO.

 

Qualifications

• Associate’s degree in business administration, Health Care Administration, Finance or Accounting or related field preferred
• Professional Coder Certification required.
• At least 3 years of experience in medical billing/revenue cycle management, with 2+ years in a supervisory role.
• Experience in a Federally Qualified Health Center (FQHC) or community health setting strongly preferred.
• Working knowledge of ICD-10, and CDT coding
• Proficient in analyzing revenue cycle metrics and driving process improvements.
• Excellent leadership, analytical, and problem-solving skills.
• Strong communication and interpersonal abilities to work effectively across departments.
• Attention to detail with the ability to manage multiple priorities in a fast-paced environment
• Understanding of Medicare and Medicaid billing rules and regulations for medical/behavioral health, vision, and dental
• Knowledge of medical terminology
• Proficiency in the use of Microsoft Office applications: Word, Excel, and Outlook
• Experience and understanding of third-party reimbursement regulations and methods
• Experienced in negotiation of medical costs with payers involves leveraging detailed cost reports and other data to secure favorable rates and terms, including those tied to Prospective Payment Systems (PPS).

Physical Requirements

• Prolonged periods of sitting and working on a computer.
• Ability to communicate effectively by phone, email, and in person.
• Ability to occasionally lift and move office materials up to 20 pounds.

HAHC is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, sex, national origin, age, disability, genetic information, or any other status protected by federal, state, or local law.