Revenue Cycle Management Manager

On-Site Service:

Reimbursement

Reports To:

CEO

Reporting to the CEO, The Revenue Cycle Management Manager oversees the daily operations of the billing and reimbursement team including; claims submissions, patient accounting activities, open claims, monthly reporting. In addition the RCM Manager will oversee all credentialing/health plan enrollment functions following Central City Integrated Health (CCIH) policies and procedures as well as Health Resources and Services Administration (HRSA) guidelines, ensuring the organization is compliant with location, state and federal standards, policies and guidelines, working collaboratively to create and maintain a culture of excellence to support the mission and vision of CCIH.

Essential Duties and Responsibilities

•Leads the operations of the revenue cycle management division, including; claims submission, payment posting, fee schedule review, overview of provider credentialing and monthly reporting.

•Assists in performing personnel functions such as hiring, training, terminating and conducting employee evaluations and disciplinary actions as necessary.

•Reviews and approves payroll and paid time off requests (PTO).

•Assists in writing and establishing revenue cycle management related policies and procedures.

•Ensures all providers are associated with each health plan contract and system is set up to accurately bill those health plans.

•Monitors payments received to validate they are paid according to contract terms.

•Maintains on-going relationship with health plans and stays current and trains on any changes.

•Oversees revenue cycle processes to ensure compliance with all CCIH procedures, state and federal guidelines.

•Works with IT staff to ensure systems support all billing/collection, credentialing and reporting processes.

•Maintains confidentiality of sensitive information in accordance with HIPPA regulations.

•Evaluate and initiate process improvement with manager to ensure efficient/effective day to day operations for responsible areas and stays current on any upcoming payer changes.

•Perform other duties as assigned.

•Develop and monitor service levels to ensure compliance with State, Federal, and company metrics and standards.

•Initiate ongoing and special projects including process including process improvement evaluations and analysis, of the department business development.

•Direct all operations related function of the revenue cycle, the budgetary needs of grant related activities and other agency revenues

•Supervise staff within the scope of the Revenue Cycle operations.

•Ensure department activities and outcomes are aligned with the strategic plan and the organizations mission, vision and values.

•Serve as a resource for departmental managers, clinical staff, and administration to obtain information and clarification on accurate and ethical billing standards, guidelines and regulatory requirements, and provide training on billing to clinical staff.

•Develop and monitor metrics to ensure coding and billing functions are performed efficiently as with a high degree of compliance.

•Establish and maintain working relationships within other departments within the agency.

•Develop and maintain collaborative relationships with CMS, Health plans, other business units, IT partners, and oversees training and business processes as necessary.

•Responsible for the development, implementation and management of business operations such as billing, enrollment, customer service, etc. and related initiatives.

Qualifications and Skills

•Working knowledge of insurances (e.g., Blue Cross/Blue Shield, Medicare, Medicaid, Private Pay) and their insurance billing requirements along with their website for eligibility and claims resolution

•Excellent analytical abilities; Extremely detail oriented

•Understanding of all coding systems including; CPT, ICD and HCPCS

•Knowledge of billing software programs, Microsoft Excel, and Microsoft Word

•Demonstrated ability to work cooperatively and effectively as a team player with a wide range of professional disciplines.

•Flexibility to respond efficiently to change and new requirements in the reimbursement process

•Highly motivated, proactive and self starter

•Ability to reconcile and/or balance financial documents and accounts

•Excellent administrative and organizational skills

•Excellent verbal and written communication skills

Education / Experience

•Associate Degree in related field required

•Minimum of 5 years experience in Medical Billing within the Healthcare environment required

Credentialing / licensure

•Experience in Federally Qualified Health Centers is highly desired.

•Previous management experience including responsibilities for hiring, training, assigning work and managing performances of staff.

•Health Insurance and project management experience.

•Ability to not only be a strategic thinker & planner, but be willing to work alongside your direct reports when necessary.

SUBMIT RESUMES TO:

tconte@centralcityhealth.com and
dhumphries@centralcityhealth.com

Central City Integrated Health
17950 Woodward Ave.
Detroit, Michigan 48203