Job Description

Position Summary

The Revenue Cycle Manager is responsible for the strategic oversight and day-to-day management of the hospital's financial health. This role leads the Billing and Coding teams in a specialized pediatric environment, ensuring high-quality charge capture, accurate coding, and timely reimbursement.

A critical component of this role includes leading the department through a transition from legacy systems (Meditech and Athena) to an Epic platform, while maintaining expert compliance with Illinois Medicaid regulations and pediatric-specific billing requirements.

Key Responsibilities

Leadership & Supervision
• Direct Supervision: Manage, mentor, and evaluate the performance of Billing and Coding specialists.
• Staff Development: Provide continuous training on pediatric-specific coding (ICD-10-CM, CPT, HCPCS) and evolving payer regulations.
• Workflow Optimization: Establish departmental KPIs (e.g., Days in AR, Clean Claim Rate, Denial Rate) and hold staff accountable to production standards.

Systems & Implementation
• Legacy Management: Oversee current revenue operations within Meditech (Hospital/Inpatient) and Athena (Ambulatory/Outpatient) to ensure no revenue leakage during the transition.
• Epic Implementation: Serve as the Revenue Cycle Subject Matter Expert (SME) for the Epic go-live. Duties include workflow design, system testing, data migration validation, and end-user training for the billing/coding modules.
• Interoperability: Ensure seamless data flow between legacy archives and the new Epic environment.

Illinois Medicaid & Pediatric Compliance
• Regulatory Expertise: Serve as the primary resource for Illinois Medicaid (HFS) guidelines, including Managed Care Organizations (MCOs) and the All Kids program.
• Pediatric Billing: Manage complex pediatric billing scenarios, including neonatal care, rehabilitative therapy, and long-term pediatric chronic care.
• Audit & Compliance: Conduct internal audits to ensure coding accuracy and compliance with state and federal healthcare laws.

Financial Operations
• Denial Management: Analyze denial trends and implement root-cause solutions to reduce rejections from Illinois Medicaid and commercial payers.
• Reporting: Prepare monthly financial reports and dashboards for senior leadership regarding AR aging and cash collection targets.
• Liaison: Act as the bridge between clinical departments and the finance office to ensure clinical documentation supports billed services

Qualifications

Qualifications

• Education: Bachelor's degree in Healthcare Administration, Finance, or a related field (Master's preferred).

• Experience: * Minimum 5+ years in Healthcare Revenue Cycle Management.

o Proven experience in a supervisory role overseeing billing and coding professionals.

o Direct experience with Illinois Medicaid reimbursement and policy.

• Technical Skills: * Proficiency in Meditech and AthenaIDX/One.

o Epic Certification or previous experience leading an Epic Implementation (Resolute Hospital Billing/Professional Billing) is highly preferred.
• Certifications: CPC (Certified Professional Coder), CCS (Certified Coding Specialist), or CRCR (Certified Revenue Cycle Representative) preferred

Required Competencies
• Change Management: Ability to lead a team through the technical and emotional challenges of a major EHR transition.

• Analytical Thinking: Deep understanding of healthcare data to identify trends in underpayments or billing errors.
• Pediatric Focus: Sensitivity to the unique billing needs of a small, 39-bed children's facility.

Additional Information