Revenue Cycle Manager

Description

The Revenue Cycle Manager manages the workflow and process of the billing revenue cycle using data analytics.  This role focuses on maximum reimbursement and compliance with the department and healthcare governing agencies.  Responsible for improving processes by redesign, cost-benefit analysis and technical solutions.  Responsibilities include all aspects of the revenue cycle system support including performance management, development, documentation, testing, training and upgrades.

Duties and responsibilities

• Improve revenue cycle production and efficiency by reviewing and analyzing reports and workflow processes and recommending changes that will positively impact the revenue cycle and help the company operate according to industry benchmarks and meet AR performance goals and productivity

• Analyze payment and charge discrepancies to determine issues, area of responsibility and assist in the development of corrective action plans

• Act as a liaison with payers to resolve payment discrepancies

• Design metrics to measure staff performance

• Compare billing from region to region on top codes/payers/reimbursement rates

• Provide month end analytics to show charge, payment, days in AR, payer mixes and denial trends

• Design metrics for reassuring denial percentages by site/denial type/CPT

• Responsible for ad-hoc reporting requests as needed

• Provide detailed analysis for charge and payment fluctuations for specific providers

• Manager AR staff

• Meet with staff regularly to review denial trends/processes/procedures

• Allocate staff to AR assignments based on highest return on investment for time spent vs. revenue generated

• Update practice management system configuration as needed to ensure accurate billing of claims

• Responsible for all daily communications from all medical practice locations

• Identify revenue holdups as quickly as possible/coordinate timely resolution

• Work with claims clearinghouse to set up new payers/troubleshoot billing errors

• Performs other duties, as required and assigned.

• Meet with staff regularly to review denial trends/processes/procedures

• Allocate staff to AR assignments based on highest return on investment for time spent vs. revenue generated

• Update practice management system configuration as needed to ensure accurate billing of claims

• Responsible for all daily communications from all medical practice locations

• Identify revenue holdups as quickly as possible/coordinate timely resolution

• Work with claims clearinghouse to set up new payers/troubleshoot billing errors

• Adhere to and uphold all applicable federal and state compliance regulations as well as NSPC’s Code of Conduct and Employee Handbook, compliance policies and procedures, and applicable healthcare fraud, waste and abuse laws. Ensure adherence to these compliance standards among all NSPC colleagues, as directed, for those responsible to manage and oversee.

• Performs other duties, as required and assigned.

Requirements

• Bachelor’s degree

• A minimum of three years of patient accounting or similar experience

• General experience with CPT coding and 3rd party billing requirements

• Ability to perform all duties in an independent manner with minimal direction and supervision

• Excellent organizational/multi-tasking skills with acute attention to detail

• Working knowledge of Medicare, Medicaid, BC/BS, WC, Managed Care and commercial insurance carriers biling regulations

• Superior proficiency with Microsoft Office Suite 

• Must have excellent excel skills including pivot table experience