Revenue Cycle Manager

Kalispell, MT

$76,778 - $98,770 a year

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Job Details

Profession: Finance

Type: Full Time

Revenue Cycle Manager 
 

Overview: An exempt, management position responsible for all aspects of the revenue cycle. The position defines and provides necessary support and leadership to achieve department goals and objectives. Provides oversight and functions as it relates to managing all aspects of the Revenue Cycle including, but not limited to billing and claims follow-up, collections, revenue integrity, and all other matters related to accounts receivable. Serves as a subject matter expert on contemporary best practices for revenue cycle workflows, team integration, and excellence in achieving executive goals.
 

Education: Bachelor’s degree required in business administration, finance, or health administration or equivalent degree.

Experience: 5+ years of progressive Revenue Cycle Management and leadership experience with a strong background in managing revenue cycle operations in a large multi-facility organization. 

 

Essential Job Responsibilities:

  • Achievement of annual and periodic goals for key performance metrics of revenue cycle performance and the organization’s overall financial performance while ensuring consistent, compliant billing practices in conjunction with all governmental regulations and other third-party payer requirements.
  • Understands, develops, implements, and analyzes key performance measures for continuous improvement. Identifies specific trends or issues and communicates status and resolution with leadership.
  • Review and assess the billing and receivables infrastructure, processes, and workflows to continue the organization’s progress toward enhanced accountability and consistency, patient safety, and patient satisfaction.
  • Leads process improvement and optimization initiatives to achieve best practices and positively impact net revenue and cash flow performance.
  • Maintains contemporary working knowledge of all market payor agreements and works with CEO, CNO, and CFO when negotiations require revenue cycle contribution.
  • Establishes a culture of excellence and responsiveness expectations for self and others. Demonstrates expectations through own actions and ensures professional leadership is maintained.
  • Manages the precertification process between the physician practice and the hospitals/surgery centers and tracks statistical information monthly.
  • Manages the filing and resolution of claims with individual carriers or agencies.
  • Manages the collection of accounts, the maintenance of the Medicare bad debt, and the outsourcing of account receivables following appropriate protocols.
  • Assists revenue integrity analysts in producing results that lead directly to action.
  • Maintains knowledge of all workflows related to outsourced functions of the revenue cycle department.
  • Manage revenue cycle vendor relations to ensure optimal operational efficiency.
  • Provides reporting to support monthly financial statement preparation.
  • Supervises, trains, and mentors assigned personnel. Evaluate performance and recommend merit increases, promotions, and disciplinary actions.
  • Manages the department within the established budget as related to personnel.
  • Manages to update of the contract matrix with accurate terms and fee schedules and establishes a common reimbursement grid by procedure code.
  • Serves as a knowledgeable resource in resolving insurance claim processing issues.
  • Monitors changes in the medical insurance industry and adjusts procedures accordingly. Aggressively pursues cost reimbursement through settlement negotiations.
  • Reviews and evaluates third-party claim policies and procedures for insurance plans, and develops new procedures to improve the quality and quantity of work processed.
  • Maintains knowledge of and complies with established policies and procedures.
  • Initiates and answers pertinent correspondence. Prepares and writes reports. Maintains required records and files.
  • Assists in the care and upkeep of department equipment and supplies.
  • Attends required meetings and participates in committees as requested.
  • Participates in professional development activities and maintains professional affiliations.
  • Maintains patient confidentiality.
  • Other duties as assigned. 
     


 

Performance Requirements:

  • Must have knowledge of hospital and physician practice operations, with preference in the area of multiple specialty surgical procedures.
  • Billing/collection practices and methodologies as they relate to critical access hospitals, ambulatory surgical centers, and rural health clinics.
  • Basic coding, CPT, diagnosis, and HCPCS codes.
  • Third-party payer procedures practices and contracts.
  • Governmental legal and regulatory provisions related to billing and collection activities.
  • Data analysis, systems design, problem identification, and medical data processing practice. 
     

Skills:

  • Skill in establishing and maintaining effective working relationships with other employees, patients, physicians, insurance organizations, and the public.
  • Computer applications.
  • Analytical and statistical reporting.
  • Use of Excel spreadsheets for monitoring statistics.

Abilities:

  • Ability to interact courteously with patients, physicians, co-workers, and others.
  • Communicate clearly and follow written and oral instructions.
  • Resolve conflicts productively.
  • Manage and mentor supervisory staff.

 

Equipment Operated: Standard office equipment including computers, scanners, fax machines, copiers, printers, telephones, postage machines etc.

Work Environment: The position is in a well-lighted office environment. Occasional evening and weekend work.

Mental/Physical Requirements: Involves sitting approximately 90 percent of the day, walking, bending, stretching, or standing the remainder. May require lifting up to 30 pounds.