Medical Revenue Cycle Manager

SUMMARY :

• Responsible for billing team leadership, subject matter expertise and performing a variety of regular tasks to ensure timely and comprehensive billing and collections for Medical and Dental services rendered by First Choice Community Health Center (FCCHC) providers.
• Supervises billing specialists to ensure all tasks are completed timely and accurately.
• The Revenue Cycle Manager is expected to devote 50% of work time to learn leadership and subject matter expert responsibilities.  The Revenue Cycle Manager should proactively seek to further develop billing process competencies; and assist in implementation of process improvements.  ESSENTIAL DUTIES AND RESPONSIBILITIES Team Leadership Supervise and coordinate the workload of the billing staff to ensure all task are completed accurately and in a timely manner.
• Define and communicate current and new billing tasks and definitions of the billing team.
• Recommend and report billing issues of concern related to clinic operations.
• Run, work and manage reports for the purpose of verifying quality and completeness of various data entry and other functions in the billing EMR system.
• Communicate with FCCHC clinic staff about missing and erroneous data (impeding claim submission) and ensure the completion and correction of the same.
• Work collaboratively with other members of the organization to maximize accuracy and completeness of patient claims and the promptness of the billing cycle.
• Troubleshoot other problems in various billing processes and document to resolution problems discovered.
• Maintain and control documentation of billing processes.
• Execute quality controls processes to ensure consistent billing and collection.
• Monitor third-party coverage contracts, ensuring that current contractual terms are understood and adopted correctly.
• Assist accounting with reconciling the EMR's system monthly patient claim deposits to the general ledger accounts.  Assist Director of Finance in completion of the annual costs report, financial audit, annual UDS report, and any other required annual government reporting.
• Create and foster an environment that encourages professional growth of the billing team.
• Other duties as assigned.
• Billing Subject Matter Expert Study and evaluate new and changing billing requirements and recommend solutions.
• Work directly with providers and clinic operations to revise processes and resolve issues, if required.
• Document significant billing changes and methods of management awareness.
• Monitor changing standards and methods in billing to ensure FCCHC methods and processes are current.
• Organizing and Performing Other Tasks  Manage and coordinate the billing team's work results for quality, accuracy, and timeliness.
• Oversee and review the transmission of patient claims in the EMR system and other electronic and paper claims processing.
• Follow-up on unpaid claims with standard billing cycle time frame.
• Oversee payment processing for accuracy and compliance.
• Provide excellent customer service to patients inquiring about their accounts and process refund requests, if applicable.
• Providing ongoing orientation and training to billing staff.
• REQUIRED SKILLS AND ABILITIES Proficient in internet use and Microsoft Office, including Outlook, Word, and Excel.'Strong attention to detail and ability to manage high volumes of work efficiently.
• Effective communicator with patients, insurance payors, and internal staff to resolve billing and claims issues.
• Excellent customer service skills for engaging with patients and families regarding medical and dental claims.
• Strong problem-solving skills to address discrepancies, denials, appeals, and collections.
• Ability to prioritize tasks, delegate when appropriate, and manage conflict constructively.
• Team-oriented with the ability to work independently and follow established policies and procedures.
• Demonstrated commitment to equity, inclusion, and respectful collaboration with diverse populations.In-depth knowledge of insurance guidelines (HMO / PPO, Medicare, Medicaid, etc.) and billing practices.
• Familiarity with CPT and ICD-10 coding; working knowledge of EMRs and billing systems.
• Certified coding certificate or equivalent experience required.

QUALIFICATION REQUIREMENTS :

EDUCATION and / or EXPERIENCE :

LANGUAGE SKILLS :

MATHEMATICAL SKILLS :

REASONING ABILITY :

COMPETENCY / SKILLS REQUIREMENTS :

CERTIFICATES, LICENSES, REGISTRATIONS :

PHYSICAL / MENTAL DEMANDS :

WORK ENVIRONMENT :