Senior Advisor, System Administrator, Revenue Cycle Management

What Revenue Cycle Management (RCM) contributes to Cardinal Health

Practice Operations Management oversees the business and administrative operations of a medical practice.

Revenue Cycle Management manages a team focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue. The revenue cycle shadows the entire patient care journey and begins with patient appointment scheduling and ends when the patient’s account balance is zero. Directly supporting cCare, the largest private oncology practice in California, our experienced revenue cycle management specialists simplify and optimize the practice’s revenue cycle, from prior authorization through billing and collections.

Job Purpose:   

This position is responsible for the management and maintenance of the revenue cycle practice management system, including the accurate loading and mapping of fee schedules, effective CPT code management, the upkeep of the ICD-10 diagnosis directory, and insurance plan management. The specialist will maintain the directory of locations and providers in the practice management system. This role aims to enhance billing accuracy, streamline operations, and ultimately support the organization’s financial reporting.  

Essential Functions: 

• Oversee the day-to-day operations of the revenue cycle management system to ensure optimal performance 
• Monitor system updates and troubleshoot as they arise, collaborating with IT and vendor support as necessary 
• Conduct regular audits of system data to ensure accuracy  
• Configure and maintain insurance plan details in the revenue cycle management system, including plan names and reimbursement types 
• Ensure all insurance plans are set up to proper track revenue associated to managed care contracts 
• Collaborate with Revenue Cycle team to establish contract groups, ensuring revenue is attributed to the correct contract based on provider, group and plan type 
• Use analytics to identify areas for improvement in insurance plan management and overall revenue cycle efficiency 
• Load, update and maintain fee schedules within revenue cycle practice management system 
• Ensure proper loading of fee schedule codes to corresponding fees and services 
• Ensure proper mapping of fee schedule codes to provider profiles 
• Configure and maintain accurate insurance carrier mappings within practice management, EHR, billing, and clearinghouse systems. 
• Manage the setup, maintenance, and updates of CPT codes within the practice management system.  
• Work with vendor to ensure new and deleted codes are updated timely. Activate codes as needed to support timely billing of new codes 
• Work with system vendor to ensure the maintenance of the ICD-10 directory is completed timely 
• Manage the ongoing maintenance of provider and location records in the revenue cycle practice management system, including onboarding new providers and locations, updating information for existing providers and locations, and processing terminations.  
• Collaborate with operations and credentialing to ensure that all provider and location records are current 
• Act as a resource for questions and troubleshooting related to the revenue system practice management system 
• Generate and analyze monthly fee schedule reports to identify trends or discrepancies that are impact financial reporting 

Qualifications

• 8-12 years of experience, preferred
• Bachelor's degree in related field, or equivalent work experience, preferred
• At least five (5