Revenue Cycle Manager

Job Overview: The Revenue Cycle Manager (RCM) is accountable for ensuring the consistency and quality of the procedures and best practices for all revenue cycle operations including charge capture, billing, payment posting, collections & follow-up, denials management, billing audits, and revenue cycle data reporting. In conjunction with other departments, the revenue cycle manager will contribute to the day-to-day operations on all issues related to the revenue cycle function, provide analysis, create written processes and train others in implementing a cross functional revenue cycle team. This position requires current knowledge of governmental and commercial insurance rules and regulations, including regulatory compliance requirements related to the billing of services

This individual must be passionate about fostering cross-departmental cooperation and recognize the challenges faced by the clinical, billing, and financial department. They must ensure their team mirrors this understanding and does not disrupt the existing culture of mutual respect and dedication to our clients. The ideal candidate is a detail-oriented leader who can analyze, optimize, and scale systems while maintaining a team-centered and mission-aligned approach.

Reports To: Chief Financial Officer

Supervising Duties: Billing and Authorization Specialists

Work Schedule: Mon-Fri, 8a-4:30p

Employee Classification: Salary, full-time, exempt

Qualifications:

• Associates degree in business related field. A combination of appropriate education and at least 5 year’s supervisory experience in a medical billing setting. This may be substituted for the minimum education and experience requirement.
• Minimum 3 years of Healthcare Administration experience (preferred)
• Strong, in-depth knowledge of revenue cycle management principles and practices including medical or behavioral health billing, coding, collections, managed care contracts, regulatory compliance, payor enrollment/credentialing, and financial reporting.
• Ability to lead, influence, and work collaboratively with others, develop and maintain strong relationships throughout the organization.
• Ability to multitask and prioritize tasks, projects, and demands with a sense of urgency and positivity.
• Spanish bilingual (preferred)

Essential Duties & Responsibilities:

• Responsible for ensuring all client billing functions (billing, collections, cash management, reporting and credentialing) are operating efficiently and effectively.
• Responsible for managing client billing staff, understanding their job functions, and maintaining awareness of process flow and equitable work distribution.
• Capable of performing all client billing functions. Provides for training of incoming department staff and covers any needed functions in employee absence.
• Responsible for developing and monitoring key performance indicators for billing department.
• Supervises, trains, orients and evaluates performance of revenue cycle staff. Develops and implements evaluation tools and measures staff efficiency and effectiveness.
• Holds regularly-scheduled meetings with other department supervisors and keeps them abreast of important issues related to revenue cycle operations.
• Maintains knowledge of health insurance requirements for credentialing. Performs site and provider credentialing and recredentialing functions including but not limited to verifying education and licensure, completing and monitoring applications, obtaining NPI numbers, etc.
• Ensures that password and login information for insurance related accounts is current and communicates changes to concerned parties.
• Develops policies and procedures for all points of the revenue cycle including, but not limited to, charge capture, data entry, payment posting, insurance follow up, collections and denials management.
• Troubleshoots problems associated with missed or unbilled charges, payment delays, denials, and other revenue cycle issues.
• Provides direction on the follow-up process for all payers, including claim correction and appeals process.
• Working closely with the Chief Financial Officer, reviewing and reconciling the month-end close process.
• Ensures compliance, monitors and adheres to applicable Federal, State, and local laws and regulations. Conducts audits for coding and documentation accuracy and reporting information as requested.
• Conducts and leads the internal audit process for billing
• Assists in developing an expansion plan for adding capacity to scale department and other processes to handle rapid growth.
• Create a training manual for revenue cycle management processes.
• Provides ongoing support and training on all aspects of billing and EHR software.
• Continually seeks ways and means for improving the delivery and support of revenue cycle activities and programs.
• Assists with special projects and assumes additional duties as assigned by the CFO
• Stay informed of payor changes and communicate such changes to the Clinical department and other relevant parties within the agency.

Additional Responsibilities:

• Interacts regularly with St, Gerard stakeholders and key St. Gerard House Personnel.
• Uphold all SGH Values and follow the Center’s policies and procedures
• Comply and ensure that others are complying with all necessary standards and regulations (HIPAA, Child Care Licensure, DCDEE, BACB, etc.) and maintain any required credential or licensure.
• Other projects as needed.