Revenue Cycle Manager
The Revenue Cycle Manager is responsible for directing and coordinating the overall functions of patient billing to ensure maximization of cash flow while improving patient, physician, and other customer relations. This position requires an in-depth understanding of coding and compliance rules and regulations; accurate claims submissions, and administration of billing and associated processes. Requires strong managerial, leadership, and business office skills, including critical thinking and the ability to produce and present detailed billing activity reports.
Essential Position Responsibilities:
- Oversees the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management. Analyze billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues including but not limited to denials, appeals, waivers, rebilling, collection.
- Direct and manages the revenue cycle management staff (and independent contractors). Supervises departmental personnel, which includes work allocation, training, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance. Provides, oversees, and/or coordinates the provision of training for new and existing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques.
- Prepares and analyzes accounts receivable reports, weekly and monthly financial reports, and insurance contracts. Collects and compiles accurate statistical reports.
- Audits current procedures to monitor and improve efficiency of billing and collections operations. Reviews and interprets operational data to assess need for procedural revisions and enhancements; participates in the design and implementation of specific systems to enhance revenue and operating efficiency.
- Ensures that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements. Develops and implements departmental policies and procedures.
- Keeps up to date with insurance carrier rule changes. Understands and remains updated with current coding and billing regulations and compliance requirements. Performs other job-related duties as assigned.
Supervisory Responsibilities: Supervises Revenue Cycle Analyst, Medical Billing Specialists and Medical Payment Posters.
- Associates degree, preferably in business administration or related field.
- Bachelor's Degree preferred.
- Minimum of five (5) years Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system, with a deep understanding of medical billing rules and regulations.
- Two (2) years supervisory or management experience preferred.
Working Conditions and Equipment
- Indoors under normal office conditions.
- Use of personal computer, 10-key calculator, copy machine, fax machine and other standard office equipment.
- Monday thru Friday, normal business hours with overtime as needed.
- At least five years of experience in revenue cycle management processes pursuing reimbursement from Medicare, Medicaid, Private Insurance, and all other payer classes with a strong understanding of billing processes and requirements.
- Supervisory experience in delegating, guiding, directing, counseling and evaluating subordinates. Ability to collaborate with other departments to accomplish common objectives.
- Excellent communication skills to work effectively with management and staff at various levels in the organization and with external healthcare providers and patients.
- Knowledge of processes and internal controls in a business environment and experience with business process reengineering and change management projects. Ability to implement a change management program.
- Strong organizational skills and demonstrated ability to remain flexible in a demanding work environment and to adapt to a rapidly changing environment.
- Experience with CPR+ or other billing software, advanced knowledge of spreadsheet, word processing and presentation applications.
- Demonstrate a professional, positive attitude.
Care Done Right
For over 90 years, Pharmacare Hawaii has been providing care to its patients with the same Aloha Spirit as they did for generations. Today this third generation locally owned and operated pharmacy employs nearly 200 employees over its locations on Oahu and Hilo. Be part of the team that is committed to helping improve the health of our community.
2016 Hawaii Business Magazine
Top 250 Company
Sun, 2 Jul 2017 14:32:28 PDT