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Revenue Cycle Manager
POSITION SUMMARY:
The Revenue Cycle Manager is an essential member of a high performing management team who oversees client account activities, clinician/provider privileging and credentialing functions. The manager ensures the organization is compliant with local, state, and federal standards, policies, and guidelines. Work collaboratively to create and maintain a culture of excellence and dedication to providing compassionate and high-quality care to the people we serve and the community.
EDUCATION AND EXPERIENCE:
- Bachelor’s degree or higher in business, healthcare administration or another related field.
- At least two (2) years’ previous experience in a supervisory or management capacity required.
DUTIES & RESPONSIBILITIES:
- Oversee and optimize the end-to-end revenue cycle, including charge entry, coding, claims submission, payment posting, and collections.
- Develop, implement, and maintain revenue cycle policies and procedures
- Manage daily operations of the revenue cycle department to meet financial and operational goals
- Ensure accuracy and timeliness in account reconciliation, pre-collection, and post-collection processes
- Investigate and resolve billing and authorization issues across public and private payers.
- Maintain oversight of Service Activity Log processes to ensure regulatory compliance as well as state and federal guidelines.
- Lead denial management efforts, including identification, analysis, and resolution of claim denials and rejections
- Implement strategies to reduce A/R days, improve collections, and enhance profitability
- Analyze payer contracts and reimbursement trends to optimize revenue
- Recommend and implement process improvements to reduce errors and improve outcomes
- Basic denial trend analysis and reporting
- Ensure adherence to HIPAA, payer requirements, and federal/state regulations
- Maintain up-to-date knowledge of payment reform and industry changes
- Oversee internal and external audits, including quarterly coding audits, and implement corrective actions
- Ensure provider documentation is completed accurately and within required timelines
- Hands-on problem-solver in all aspects of collecting and billing including but not limited to working with funding partners.
- Performs personnel functions such as hiring, training, terminating, and conducting employee evaluations and disciplinary actions, as necessary.
- Ensure accuracy and integrity of patient billing information and internal records
- Responsible for updating and correcting authorization errors that prevent services from being billed.
- Monitors and maintains insurance contracts with all payers.
- Ensures all providers are associated with each health plan contract and system is set up to accurately bill those health plans.
- Stays abreast of payment reform changes and advises the administration team of these changes and provides recommendations for changes necessary.
- Lead end-to-end provider credentialing and enrollment processes
- Ensure timely credentialing/privileging, re-credentialing, and payer enrollment of behavioral health employees and clinic locations.
- Enroll, update and re-attest as necessary for all health plan enrollment activity, keeping a detailed listing of all providers and their status with each contracted health plan.
- Establish and maintain compliant credentialing policies and workflows
- Serve as the primary contact for credentialing with health plans, auditors, and regulatory agencies
- Cooperates in any investigation related to personnel, licensing, accreditation, or other circumstances.
- Communicate in a professional manner with various Starfish Family Services team members, Detroit Wayne Integrated Health Network (DWIHN), health plans, and other entities.
- Evaluate and initiate process improvement with clinical leadership to ensure efficient/effective day to day operations for responsible areas and stay current on any upcoming payer changes.
- Provides reports and details to management team to carry out the necessary steps for a claim to be billable.
- Training and educating management team on billing practices and revenue cycle processes.
- Serves as the primary contact and expert for insurance companies as well as building and executing reports that accurately depict important business metrics and departmental metrics.
- Actively seeks opportunities to improve financial outcomes, engaging revenue cycle team members in the process.
- Responsible for following up on DWIHN risk matrix data. Provide summary and reports to senior leadership team.
- Responsible for recommending changes to the senior director that would improve service delivery.
- Support the CFO with financial reporting, audits, and cost reporting
- Enhance workflow and revenue outcomes by analyzing (clinical) operational implementations, events, and potentially extended service lines of care that may result in heightened reimbursement.
- Tracking and updating clinical reports and ensuring timely and routine updates are provided by clinical services team members.
- Completion of reports from DWIHN to include but not limited disenrollment report and MCO report.
- Participates in continued professional development including research and program presentation activities.
- Attends local, county, state, and agency meetings and training courses as required.
- Performs other duties as assigned by senior management.
KNOWLEDGE, SKILLS, & ABILITIES:
- Knowledge of general accounting principles and medical terminology.
- Knowledge and understanding of state and federal rules and regulations regarding confidentiality, compliance, release of information, Fair Debt Collection practices, and insurance regulations.
- Knowledge of principles and techniques used in negotiation as applied to service contracts and equipment purchasing.
- Effective organizational, planning and project management abilities.
- Experience in financial and programmatic presentations.
- Demonstrated creativity and flexibility.
- Ability to operate in high-pressure situations.
- Demonstrated innovative approach to problem resolution.
- Experience with credentialing/impaneling of providers/facility eligibility with payers highly preferred.
- Knowledge of ICD-10 Codes, CPT Codes, HCPCS Codes, Revenue Codes, and Place of Service Codes.
- Experience working in Behavioral Health EHR system(s).
- Intermediate level experience working in Microsoft Suite applications.
- Knowledge of community mental health treatment programs and their continuum of care.
- Knowledge of supervisory principles and practices including personnel and systems management.
- Ability to communicate effectively both orally and in writing.
- Ability to manage multiple priorities, functions independently, and demonstrate good follow through.
- Ability to work positively and productively as a member of a team of colleagues, supervisors, agency staff and collateral contacts.
- Ability and willingness to give and receive constructive feedback.
- Ability and desire for personal and professional growth and skill development.
- Must be culturally sensitive and competent in working in a multi-cultural environment.
- Must demonstrate capacity for developing autonomy and leadership among employees.
- Must demonstrate skills in working tactfully with others.
- Flexible in assumption of responsibilities.
- Must maintain ethical and professional standards.
- Ability and willingness to work with all members of the community regardless of race, age, gender and cultural or ethnic background.
- Ability to represent the agency in a professional manner.
LICENSING AND OTHER REQUIREMENTS:
- Must have a valid State of Michigan driver’s license and automobile insurance.
Starfish Family Services is an Equal Opportunity Employer
EOE/M/F/D/V
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