Revenue Cycle Manager

SUMMARY:

The Revenue Cycle Manager serves as the primary liaison with the Revenue Cycle partner and Alivio’s management and support staff to ensure timely completion of charts, submission of claims, review of remittances, explanation of benefits, denials, appeals. Utilize their knowledge, experience, and skills to suggest changes in revenue cycle processes to bring efficiencies in the revenue cycle. Supervises, trains, and evaluates support staff in billing and collections procedures and develops policies and procedures regarding such, under the supervision of the CFO. Monitors patient and insurance accounts receivables, charges, rejected claims, and bad-debt and report corrective measures to Management. Partner with internal and external resources to maintain outstanding accounts receivable to an average of 45 days or less. 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

•  This is an on-site, in-person position.
• Reviews and reports monthly remittance to the Finance Department, Revenue Cycle partners, ensuring that logs are maintained and completed in a timely and organized manner.
•  Reviews rejection of claims to determine appropriate course of action. 
•  Acts as key liaison between Alivio and Insurance plans to understand and implement changes that affect submission of claims and timely reimbursements. 
•  Works closely with the Finance Department to review and analyze revenue cycle data for the purpose of recognizing revenue, including gross charges, allowances/adjustments, payments, and bad debt. 
•  Monitors the sliding fee discount program for uninsured patients. Review and update policies and procedures applicable to the discount program on a regular basis.
•  Provides training to Alivio staff on different insurance plans as it applies to accurate registration of patient for their visit, use of procedure codes specific to payers. 
•  Reviews outstanding account receivables for follow-up as appropriate. Collaborates with Revenue Cycle partner to determine appropriate course of action on outstanding accounts receivable.
•  Review and classify patient accounts for bad debt and other adjustment in accordance with Alivio Medical Center policy.
•  Ensures that claims are within a maximum of 14 days following the date of service. Collaborates with internal and external partners to achieve the timely claim submission target.
•  Develops and maintains written policies for billing procedures and daily operations of the billing department including month-end and year-end closing.
•  Partners with external vendors to ensure timeliness and accuracy of statements sent to patients for co-pay, co-insurance, and deductibles. 
•  Maintains comprehensive knowledge of billing for medical, behavioral health, accident/workers’ compensation, and dental visits.
•  Reviews bulletins issued by Medicare, Medicaid, Insurance plans to understand updates in billing guidelines. Educate providers and staff on the guidance and relevant updates on billing.
•  Analyzes current billing staff requirements and positions as they correlate with department needs.
•  Performs month-end, and year-end close activities in the billing software to ensure accurate capture of activities within the period.
•  Prepares monthly and annual reports tabulating visits, encounters, charges, allowances/adjustments, payments by various variables.
•  Provides the relevant visit/encounter data for preparation of cost reports and Uniform Data System (UDS) reports.
•  Meets periodically with Insurance plan representatives, Alivio staff, external partners on the state of the Revenue Cycle.
•  Attends and participates in the Quality Assurance Committee, and Risk Management meetings and activities.
•  Responsible for the supervision and performance management of Alivio’s billing department staff.
•  Performs other duties as assigned by Chief Financial Officer.

This position requires compliance with all of Alivio’s written standards, including its Standards of Conduct, Joint Commission standards, all policies and procedures and Corporate Compliance requirements. Compliance will be considered as part of the regular performance evaluation.

SUPERVISORY RESPONSIBILITIES    

Manages and supervises staff listed below, including hiring, training, evaluating and managing performance to meet departmental efficiency and performance measures in keeping with the Union Collective Bargaining Agreement (CBA), Personnel Policies and Procedures and prevailing employment laws as appropriate.

·   Billing Department Staff

KEY INTERRELATIONSHIPS:

·         

·        Executive Management

·        Finance Department Staff

·        HIT Department Staff

·        Revenue Cycle Partner

·        Practice Managers

WORKING CONDITIONS:

OSHA Category 3 – Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues are not a condition of employment.

QUALIFICATIONS:

Education:

• Bachelor’s degree from an accredited college or university. Appropriate college courses/certification required and may be accepted in lieu of degree. 

Certification or Licensure:

• CPC or AHIMA certification preferred.

Experience:

• Minimum 3-5 years billing or coding experience required. Experience in Primary care (adult and pediatric), behavioral health, dental billing. Previous managerial and staff training experience required. 

Preferred Experience

Special Training:

• Federally Qualified Health Center billing experience highly desired.  Knowledge of billing processes using eClinical Works.

Demonstrated Competencies:

·        Comprehensive knowledge of end-to-end revenue cycle operations (registration, coding, billing, collections, etc).

·        Expertise in reimbursement methodologies (commercial, Medicaid, Medicare, etc)

·        Strong understanding of payer contracts and regulatory requirements

·        Denial prevention and appeals management expertise

·        Team leadership and performance management

·        Staff development and coaching

·        Change management and process improvement leadership

·        Revenue cycle optimization

·        Policy and procedure development

COMPENSATION & BENEFITS

• Salary Range: $70,000 - $80,000 commensurate with education and experience
• Full health benefits including: Medical, Dental, Vision, Short and Long Term Disability, Life Insurance
• 403b Retirement Plan
• Paid Time Off: Vacation, Paid Sick Leave, and Paid Leave