This position manages all operational and strategic leadership functions related to the entire Revenue Department and all centralized revenue cycle functions in a multi-disciplinary, multi-specialty medical clinic setting. They oversee the teams and departments that manage accounts, communications with payor sources, collections, contract analysis, cash posting, billing transactions with clients, medical records and report creation: namely the patient collections, coding, insurance verification, insurance collections, medical records, liens, and accounts receivable departments within the Revenue Department. They implement quality control standards and audits to ensure that all coding is properly billed under the industry guidelines as set by the AAPC.
Position Duties:
The position requires the following primary duties to be successful:
Managing the multiple components of the revenue cycle include pre-authorization, eligibility and benefits verification, claims submission, payments and payment posting, claims denial management, reporting, and any other functions which involve patient revenue management.
Supervising the Coding and Charges Department in various duties, such as medical documentation review, proper CPT and ICD-10 documentation and entry, timely entry of all charges, and performing of quality control audits
Implementing and managing a system to ensure that accurate billing information is entered into the billing system
Setting and meeting collections goals by department and for the organization overall by managing the collection processes for individual patients, attorneys, and insurance companies.
Managing staff performance by providing regular feedback, performance reviews, and one-on-one meetings
Overseeing the hiring and training of staff
Attendees monthly and/or quarterly AAPC seminars to assure all coding is aligned with the industry standard and changes
Planning and structuring the department workflow and staffing
Correctly coding diagnoses and procedures
Ensuring proper timely filing of all claims by implementing a timely standard of charge entry
Annually reviewing and updating of charge master
Negotiating contracts with insurance companies
Collaborates professionally with clinical staff and all other departments to maintain unity and successful resolve outstanding request
Keeping updated records and tracking reports as required by management
Insuring proper filing of liens
Other duties as requested of the Revenue Cycle Manager that are consistent with and appropriate for this position title and role.
Position Expectations:
To perform the position successfully, an individual is expected to:
Provide proven experience as a manager of correct coding and documentation in the healthcare industry
Demonstrable experience with coding and charge entry
Knowledge of AAPC guidelines and industry correct coding standards
Sound knowledge of healthcare billing rules & regulations
Working knowledge of MS Office & Excel
Excellent communication and interpersonal skills
The ability to negotiate and interact regularly with both insurance companies and attorneys
A strong analytical mindset
Outstanding organizational skills
Be passionate and professional
Be success-driven and metrics focused
Be smart; work smart
Have a positive attitude
Leadership by example
Be a positive agent for change/improvements within their department
Have a thorough understanding of the operations and the technology behind revenue cycle management.
Position Metrics:
The execution of the position is quantifiably measured by the following:
Establishing, managing, and meeting department goals
Maintains quality control standards for the department through documented quality control audits
Supports the successful attainment of the global revenue goal
Position Requirements:
Minimum Education Level: Bachelor's degree in Finance, Accounting, Healthcare Administration, or a related field.
Revenue cycle certification preferred.
Minimum of 5-7 years of experience in revenue cycle management, preferably in a multi-specialty medical clinic or similar setting.
Proven experience in a leadership role managing a revenue cycle team, as well as direct operational experience in all phases of medical revenue cycle
MS Office & Excel experience
Experience with EHR and PM software, specifically NextGen platform preferred.
Preferred: Ability to multi-task under time pressure. Strong communication and leadership skills
Be team oriented and able to work with various departments. Be able to make sound decisions while on the move in a fast-paced organization.
Position Miscellaneous:
40 hours per week; extended work hours from time to time to meet deadlines
Setting goals, meeting deadlines and being compliant with departmental policies
Ability to interact, engage and communicate effectively with executive management, managers and clinic employees
Physical Demands: frequent sitting; limited lifting up to 10-15 pounds; frequent manipulation of documents; frequent typing or use of keyboard