Revenue Cycle Manager
San Bernadino, CA 92408
The Revenue Cycle Manager encompasses all facets of the process of contracting for, accounting for, and collecting of the company s revenue and is responsible for overseeing and coordinating all revenue cycle activities with a goal of maximizing reimbursement in a cost-effective manner that is in compliance with federal, state and payer-specific billing requirements.
Revenue cycle activities include registration, eligibility, scheduling, charge capture, coding, charge entry, insurance filing, billing, payment entry, insurance follow-up, collections, and reimbursement analysis. The Revenue Cycle Manager is responsible for setting productivity standards, monitoring the work and productivity of the AR Representatives, and payer contracting and negotiation activities.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Manages all related fiscal operations including Insurance Verification, Coding, Accounts Receivable, Billing, Collections, and Contracting, and practice managements software maintenance.
- Reviews and enhances insurance verification, coding review, billing, collection, and payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current work flow.
- Monitors daily productions of claims, denials, and appeals.
- Maintains current knowledge of relevant insurance coding and reimbursement issues
- Ability to recognize, research and correct charging/documentation discrepancies.
- Ensures compliance with relevant federal, state, and payor-specific billing requirements.
- Maintains appropriate internal control safeguards over AR records and collection of cash.
- Responsible for payer contracting and negotiation activities.
- Reviews, monitors and recommends updates to the Clinic s fee schedule to maintain fees at levels that maximize reimbursement.
- Identifies revenue cycle issues, researches and analyzes data, identifies alternative resolutions to issues and implements solutions for improvement. In doing so, works with President, Vice President, COO, Administrator, and relevant management members and staff.
- Coordinates revenue management orientation and educational activities of clinical personnel including providers, management and staff about coding and other outstanding revenue cycle issues.
- Bachelor s degree in Finance, Business, or equivalent desired.
EXPERIENCE AND SKILLS
- NextGen experience is highly desirable.
- Experience with Medi-Cal billing is highly desirable.
- Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint)
- Knowledge of business management techniques and principles, finance in order to develop and direct Clinic revenue cycle objectives and goals and resolve complex management problems.
- Approximately three to five years of progressively more responsible medical billing related work experience necessary in order to gain full understanding of revenue cycle related activities such as coding, third party payor reimbursement, billing and collection activities, and to supervise and manage the work of both management and subordinate staff.
- Individual must have strong knowledge of medical insurance billing and collections, coding and medical terminology, as well as an overall understanding of Medicare and other third party payers.
- Interpersonal skills necessary in order to clearly and effectively communicate, both verbally and in writing, with management and staff as well as when representing the Clinic with people outside of the clinic.
- Analytical skills at a level in order to gather and analyze complex information in order to analyze data, recognize revenue cycle issues, and develop, make recommendations for resolution of issues, direct implementation of approved resolutions, and analyze effectiveness of implemented solution(s).
- A high degree of assertiveness and determination is required.