Manager, Revenue Cycle (Hybrid)

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only.  This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

Purpose of the job

Lead and optimize end-to-end revenue cycle operations for Prosano Health Solutions. Responsible for efficient billing, collections, and reimbursement processes critical to the financial health of Prosano.  Daily responsibilities will entail monitoring and managing the processing of claims to insurance, reviewing patient balances, and managing the coding/billing team. Maintain policies and procedures associated with the collection and reimbursement of services rendered.

Qualifications

REQUIRED QUALIFICATIONS

Required Work Experience

• 7 years of progressive experience in healthcare finance, business analysis, health insurance or revenue cycle management, including a minimum of 5 years in a leadership capacity.

Required Education

• High School Diploma

Required Licenses

• N/A

Required Certifications

• Medical Coding Certification

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 10 years of progressive experience in healthcare finance, business analysis, health insurance or revenue cycle management, including a minimum of 5 years in a leadership capacity.
• 5 years of experience in a multi-site or integrated health system environment
• Demonstrated success in change management and process re-engineering.
• Experience with EMR Billing configuration and processes

Preferred Education

• Bachelor’s degree in healthcare administration, Finance, Business, or related field

Preferred Licenses

• N/A

• Preferred Certifications
• Certification in Healthcare Financial Management (CHFP, CRCR, or similar)
• Certified Professional Coder (CPC) 
• Certified Coding Specialist (CCS) or Certified Coding Associate (CCA) from AHIMA.

ESSENTIAL job functions AND RESPONSIBILITIES

• Oversee all aspects of the revenue cycle including patient registration, insurance verification, coding, billing, collections, and denial management.
• Lead, mentor, and develop a high performing team of revenue cycle professionals.
• Analyze revenue cycle performance metrics and implement process improvements to enhance efficiency and reduce days in A/R
• Collaborate with clinical, IT and finance teams to ensure accurate charges are captured and in compliance with the payer’s requirements.
• Develop and maintain policies and procedures to ensure regulatory compliance and operational consistency.
• Design and develop tools and reports that lend valuable insights leveraging a combination of internal and external data.
• Monitor competitive intelligence data sources, compiling all key information specific to revenue cycle KPIs and sharing critical information/reporting wi