Job DescriptionThe Manager of Outpatient Revenue Cycle is responsible for planning, supervising, and coordinating outpatient medical billing and coding for all Community Health Center services, including ambulatory clinics, diagnostics, behavioral health, and ancillary services. This position oversees the development and implementation of monthly AR reports, policies, and processes to reduce inefficiencies and maximize revenue by improving outpatient charge capture, coding, claims submission, and collection functions. The Manager is a key member of the Community Health Center management team, conducting problem analysis and recommending solutions. Periodic travel between the Health Care District's Home Office, Lakeside Medical Center, and outpatient clinic sites may be required.
- Develops and leads a customer service-oriented team focused on outpatient revenue cycle objectives.
- Manages end-to-end outpatient billing operations, including oversight of third-party billing services, ensuring efficient work queues, claim edits resolution, and high productivity.
- Oversees outpatient charge capture and coding accuracy (CPT/HCPCS, ICD-10-CM), including E/M, observation, diagnostics, infusions/injections, minor procedures, and clinic/ancillary services.
- Ensures compliance with CMS outpatient rules (OPPS), National Correct Coding Initiative (NCCI) edits, modifier usage, medically necessary services, and payer-specific policies.
- Develops outpatient revenue cycle reports, dashboards, and KPIs (e.g., DNFB, first-pass yield, clean claim rate, denial rates, days in AR, credit balances) and presents findings to leadership.
- Provides feedback to registration, scheduling, and HIM teams to maximize performance of front-end and back-end processes affecting outpatient claims.
- Identifies, collects, and validates data related to outpatient utilization and reimbursement trends; prepares regular and ad hoc analyses for leadership.
- Works with third-party payers to assure appropriate payment for outpatient services, including contract interpretation and monitoring of payer policy changes that impact outpatient reimbursement.
- Collaborates with technical experts and business units to optimize Epic work queues, charge review, claim edit logic, and reporting for outpatient services.
- Supervises coding quality audits and compliance monitoring to ensure proper outpatient billing to Medicaid, Medicare, and commercial payers; leads coder education based on audit findings.
- Oversees timely creation and transmission of outpatient claims; audits and records payments, adjustments, and write-offs; researches, corrects, and rebills denied or rejected outpatient claims.
- Monitors production of patient statements and the collection of patient balances related to outpatient services; recommends allowances and write-offs per policy based on aged trial balance review.
- Leads root-cause analysis and remediation for top outpatient denials (e.g., medical necessity, bundling, eligibility, authorization, modifier, frequency, duplicate claims).
- Ensures charge posting staff are trained on EMR use for outpatient charge capture and documentation retrieval consistent with access and needs.
- Attends required meetings and participates on committees; maintains professional affiliations to stay current with outpatient revenue cycle trends and regulations.
- Leads staff in resolving issues related to patient financial services, especially those impacting outpatient access, pricing transparency, estimates, and collections.
- Supports emergency duties when required, which may include work in special needs or Red Cross shelters or other emergency responses.
QualificationsEducation:Bachelor's degree in Accounting, Healthcare Administration, Finance, or related field required. Equivalent combination of education and experience may substitute for minimum requirements.
Experience:Three (3) to five (5) years of experience managing outpatient coding and/or billing staff required. Experience in team building and knowledge of Managed Care, Payer Enrollment and Credentialing required. Experience in Epic strongly preferred.
Certification:Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or other relevant outpatient coding certifications preferred
Licensure:Valid Florida Driver's License required.
Registrations:N/A
Training:N/A
