Level Management
Position Type Full Time
Education Level 4 Year Degree
Category Nonprofit - Social Services
Description
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 m
