Responsible for managing significant elements of the revenue cycle related to the organization’s contractual relationships with third party payors and the Client Financial Services/Billing team. Work is distinguished by the broad scope of accountability over multiple segments of the revenue cycle impacting agency income and financial results.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Provides leadership and direction for the Billing and Collections function.
- Develops and implements controls and measures to ensure accurate and timely billing and collections in accordance with established internal and third-party payor requirements (Medicaid, Medicare, MCO, Commercial payors). This includes the cycle from submitting claims to collection and denial management.
- Responsible for denials management of claims and performs root cause analysis to determine trends for denials and addresses the underlying issues on a timely basis including following third-party payor specific requirements for disputes, appeals and reconsiderations. Utilizes clearinghouse reports to ensure denials are addressed in a timely manner by the billing team.
- Secures, maintains, and organizes managed care contracts including monitoring the terms and reimbursement criteria. Reviews and analyzes contracts routinely for financial profitability and to ensure the best interest to the agency.
- Develops, manages, and sustains relationships with third party payor representatives to communicate concerns and identify solutions. Coordinates with other internal operations including Credentialing, Clinical Support Team, Finance and Accounting, and Information Technology to ensure effective processes.
- Partners with the Information Systems department to ensure accurate contract set up in the electronic medical records and related billing systems; works with IT to implement fee and coding updates as new requirements are implemented by third-party payors; works with IT to implement system changes to take advantage of interfaces and new functionality.
- Coordinates efforts with Clinical Support Director and other organizational leaders to ensure: a positive client experience, accurate client set up, scheduling and necessary insurance verification and authorization processes occurs. Improves workflows between the various revenue cycle management groups to ensure more efficient processes.
- Report on A/R aging at the weekly RCM meeting including identifying issues that may need escalation. Works with VP of RCM to provide monthly A/R aging summary for the CFO and the Finance committee.
- Ensures patient/client balance issues are addressed in a timely manner. Oversees patient/client statement process and ensures patients/clients receive statements per agency requirements.
- Manages the day-to-day functions in the Electronic Health Records including approving claims and ensuring they are submitted to the clearinghouse per agency approved timelines.
- Responsible for managing the month end close process; work with clinical teams to ensure all transactions/revenue are captured; ensure all month end tasks are completed; generate the month end reports for finance; complete the month end reconciliation process.
- Performs data analysis in support of new or existing approaches, policies, and processes; makes recommendations to improve processes and increase efficiency within the full scope of the revenue cycle.
- Develops and proposes policies and procedures; assists with the development and preparation of fiscally appropriate budgets that enable the department to meet its objectives.
- Participates in user group revenue cycle discussions for the Electronic Health Record as well as industry groups (CBHA, IPHCA)
Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include training and hiring staff; planning, assigning, and directing work; evaluating performance, providing coaching and development, addressing concerns and resolving problems, and managing employee timecards.
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 an individual with a disability to perform the essential duties and responsibilities.
EDUCATION AND EXPERIENCE
Bachelor’s degree in Health Care Administration, Business Administration, or related field.
At least five (5) years of demonstrated expertise and experience in all facets of Revenue Cycle Management, including but not limited to utilization management practices, insurance benefits, and cost management strategies; compliance with managed care and third-party reimbursement; the revenue cycle and significance of processes at each client encounter; project management tools and methods, and negotiation as applicable to establishing payer contracts.
At least three (3) years of experience working with Medicare/Medicaid, and Managed Care Billing and Insurance plans. Experience working in Community Mental health Centers and/or Federally Qualified Health Centers preferred.
- Demonstrated knowledge of HCPCS, CPT and ICD-10 coding.
- Superior attention to detail and ability to meet deadlines. Ability to multi-task and prioritize.
- Excellent verbal/written communication skills.
- Proficient use of Electronic Health Record system and MS office suite of products.
- Ability to plan the development, implementation and monitoring of new and existing managed care contracts.
- Ability to work with others to resolve operational issues and implement strategic initiatives
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