Manager - RCM

Position: RCM Manager

Reports To: RCM Director

Classification: Exempt/Full-Time

Location: Remote

JOB DESCRIPTION:

The Revenue Cycle Manager is responsible for overseeing revenue cycle management functions including coding, billing, collections, and denial management as well as financial reporting within the organization. This position is responsible for ensuring claims, denials, and appeals are efficiently processed, and resolving billing-related issues. The Revenue Cycle Manager will minimize bad debt, improve cash flow, and effectively manage accounts receivables.

PRIMARY RESPONSIBILITIES:

• Oversee and manage entire revenue cycle including billing, coding, collections, and denial management.
• Manage relationships with external vendors for practice management software and clearinghouse vendors.
• Communicate professionally with various payers.
• Manage, develop, and mentor all revenue department staff, including billers and coders and RCM Team Leads
• Reconcile all receivables, and revenue reports and work closely with the RCM Director to review on a regular basis.
• Review and resolve issues related to claim generation and rejected/denied billings.
• Keeps abreast of all reimbursement billing procedures of third party and private insurance payers and government regulations.
• Maintains appropriate internal controls over accounts receivable, RCM processes.
• Monitors accounts sent for collection and reimbursements from insurance companies and other third-party payers.
• Reviews, monitors, and evaluates third party reimbursement, and research variances.
• Assess team members for potential, strengths and development needs and conduct career development discussions to grow the talent pipeline.

Qualifications:

• Management level experience in revenue cycle processes.
• Strong detailed knowledge of Medicare, Medicaid and Commercial Insurance billing rules and processes.
• Knowledge of general accounting principles, including revenue recognition, and their application preferred.
• Proficient in Microsoft Office with strong Excel skills.
• Strong analytical and problem- solving skills.
• Superior organizational skills with excellent attention to detail.

• Prior leadership experience.
• Revenue cycle consulting experience, such as revenue cycle outsourcing, interim management or performance improvement preferred.
• 5 years of claims processing experience in large healthcare or Health insurance operations
• Experience working with project stakeholders/business leadership teams.
• Proficient in Healthcare Revenue Cycle EMR’s, PMS Systems, and Clearing Houses.

• Demonstrated ability to lead multi-disciplinary teams through complex, medical, social and financial conversations.
• Ability to analyze trends, develop and maintain performance goals and regularly provide information to senior management.
• Must be able to demonstrate effective written and verbal communication skills, training and facilitation skills.

EXPERIENCE / EDUCATIONAL REQUIREMENTS:

Education:

Bachelor’s degree- Business or Healthcare Related Preferred.

Experience:

Five to seven years of relevant RCM industry experience in health care reimbursement, preferably in either a hospital, professional group, or community-based setting.