Position Overview:Under the direction of the Sr Director of Revenue Cycle Management, the Revenue Cycle Manager demonstrates and understands Purpose Care operations by continually increasing the revenue in a cost -effective and efficient manner. The Revenue Cycle Manager ensures compliance with HIPP A and other relevant Healthcare rules and regulations with the billing processes and procedures. The Revenue Cycle Manager leads with exceptional ethical principles and demonstrates integrity and accuracy in the accounting practices. The Revenue Cycle Manager possesses appropriate knowledge and experience to oversee the Revenue Cycle Team with excellent collaboration and communication skills.
Position Essential Duties and Responsibilities:- Prepares invoices and submits electronic claims to Medicare, Medicaid Replacement Plans, Commercial Plans, Veteran Administration Optum and other skilled entities on a daily, weekly, and/or monthly basis.
- Supervises the revenue cycle department data process in EMR for payment posting, adjustments, write offs, denials, appeals and refunds in EMR's.
- Implements all new payors and contractual rules with charged rates/service types.
- Submits Medicare Notification of Admission (NOA) within designated timeframes to avoid penalty. Verifies and confirms receipt of NOA submission by the payor.
- Collaborates with clinical staff and supervisors to assure information required for accurate billing is received.
- Performs daily, monthly, quarterly audits to confirm claim requirements are met for clean claim submission.
- Monitors claims in payor and clearinghouse portals to ensure timely receipt and acceptance, ensuring claims are processed accordingly.
- Follows up and resolves any rejected, RTP, or held claims, makes corrections daily in various portals including Medicare Direct Data Entry (DDE), Inovalon and Change Healthcare Portal (Clearinghouse).
- Creates daily deposit folders for all payors with copies of remittance advice and credit card correspondences.
- Supervises payment posting, reconciling remittance posting in EMR to balance to bank deposits.
- Maintains the Revenue Cycle Aging by working validation /claim holds and claim errors by researching and reviewing any discrepancies accounts to decrease Account Receivable days.
- Corresponds with weekly meetings regarding outstanding visits and issues.
- Manages team performance by providing regular feedback, performance reviews and one-on-meetings.
- Oversees the hiring and training of staff, and ongoing training in the revenue cycle department.
- Plans and structures the department workflow.
- Closes the book monthly for billing purposes.
- Efficiently manages client's complaints in respect of billing and collections.
- Negotiates payment arrangement with Private Pay Clients, sending statement letters on a weekly and monthly basis.
- Coordinates uncollectible accounts, sending to the attorney or collection vendor as specified, for further collection options.
- Submits the Quarterly Medicare Credit Balance Report, validating timely receipt.
Education and Experience:- Bachelor's degree in finance, accounting, business, healthcare, or related field.
- Ability to travel and be on site at PurposeCare Agency or branch office(s) as needed.
- Minimum of 4-7 years of experience in Healthcare Management.
- Proficient in all Microsoft Office applications as well as medical office software.
- Effective written and verbal communication skills.
- Experience working in a dynamic and fast-growing company environment a plus.
- Strong interpersonal and organizational skills.
- Proven experience in healthcare billing and sound knowledge of health insurance providers.
