The Revenue Cycle Manager is responsible for overseeing all aspects of the ambulance billing revenue cycle, from patient intake and charge capture through final payment resolution. This role ensures accurate billing, maximizes reimbursement, maintains compliance with federal and state regulations, and leads performance improvement initiatives within EMS billing operations while maintaining and improving internal and external customer relations.
Key Responsibilities- Oversee the entire billing workflow from intake and patient care report (PCR) review to claim submission, accounts receivable (A/R) follow ups and collections.
- Reviewing daily activities of patient accounts to ensure timelines and accuracy of revenue cycle processes.
- Ensuring accurate coding (HCPCS, ICD-10, ALS/BLS modifiers) and maintaining strict compliance with CMS and commercial payer guidelines.
- Lead responsibility for the revenue cycle operation pertaining to all pre-billing activities.
- Assists in developing and implementing long-range plans, such as specific policies and procedures to assist in solving problems associated with the overall operations.
- Monitors key performance indicators such as days in A/R, collection rates, and denial rates to report on financial health. Updating Leadership with weekly reports.
- Utilizes reporting to track measurements for performance and staff feedback, including clean claim rates and denial rates.
- Supervise all department staff, assist in recruiting, training, mentoring and staff development, ensuring department is operating at maximum efficiency and maintaining high performance.
- Track and evaluate specific staffing and performance levels needed to streamline operational steps and improve cash collections.
- Responsible for revenue cycle process and supervising staff in pre-billing, scanning, coding, collections, cash posting and accounts receivable follow up.
- Collects, manages, and presents data regarding accounts receivable, reimbursement, write offs and denials.
- Proactively identifies root cause of claim denials, executes appeals and implements strategies to prevent future rejections.
- Keeps self and staff abreast of any changes in state and federal government programs, as well as all other third-party payers.
- Maintains knowledge of and complies with all company policies, procedures, and guidelines at all times.
- Must maintain a reliable attendance record
- Completes other duties as requested and assigned
Education:- Bachelor's degree or equivalent experience in Ambulance Finance
- Healthcare Administration, Business, Finance, or related field preferred
Licensure, Certification, Registration:- CAC, CPC or CPB preferred
Experience:- 5+ Years of Medical Billing and Revenue Cycle Management experience.
- 2-3 Years direct experience in EMS or Ambulance billing or related industry
- Minimum of 3 years of responsible leadership in management or supervisory role
Knowledge, Skills and Abilities:- Expert knowledge of Ambulance fee schedules, local coverage determinations (LCDs) Medicare/Medicaid regulations and private insurance contract guidelines.
- Analytical mindset with strong attention to detail.
- Proficient knowledge level of healthcare administrative processes such as reimbursement policies, procedures, operations and associated billing regulations
- Extensive knowledge of Federal and State insurance programs
- Extensive experience in interpreting medical records and documentation protocols.
- Proficient level of medical terminology, ICD10
- Proficiency with medical billing software and EHRs
- Superior process improvement and problem-solving skills
- Excellent ability to Communicate effectively, both verbally and in writing; strong ability to interact professionally with clinical and financial stakeholders.
- Strong Analytical capabilities to gather and interpret data
- Ability to exercise sound judgment and discretion at all times
Requirements:- Must be 18 years of age or older
- Ability to meet the essential duties and physical, mental and sensory requirements of the position at all times.
- Comply with UDS drug screening at any and all times
- Satisfactory background check and MA CORI (Criminal Offender Record Information), verification required annually.
- Verification of an acceptable motor vehicle driving record, verification required annually.
Physical Requirements- Stationary Position: Frequently required to sit for long periods at a desk.
- Manual Dexterity: High level of finger dexterity to operate computers, calculators, and office machinery.
- Handling/Reaching: Frequent need to reach with hands/arms, handle files, and feel objects.
- Lifting/Moving: Ability to lift, carry, or move documents, files, or office equipment (typically up to 10-25 pounds).
- Movement: Intermittent walking, standing, bending, or stooping to access files
Mental/Cognitive Requirements- Organization: Exceptional organizational and time-management skills to handle daily tasks.
- Attention to Detail: Ability to input data accurately and read fine statistical reports.
- Communication: High-level verbal and written communication skills, including professional telephone etiquette.
- Problem-Solving: Ability to manage deadlines and resolve issues
Sensory Requirements- Vision: Close vision, peripheral vision, depth perception, and ability to adjust focus to read computer screens and printed documents.
- Hearing: Ability to hear and understand speech in person and on the telephone.
- Speech: Ability to communicate clearly in person and via phone.
