Fqhc Experience In California Revenue Cycle Manager

TrueCare is a trusted healthcare provider serving San Diego and Riverside Counties, offering compassionate and comprehensive care to underserved communities. We are committed to making healthcare accessible to everyone, regardless of income or insurance status. With a focus on culturally sensitive, affordable services, TrueCare aims to improve the health of diverse communities. Our vision is to be the premier healthcare provider in the region, delivering exceptional patient experiences through innovative, integrated care.

The Back-End Revenue Cycle Manager is responsible for managing the day-to-day activities of the billing staff to ensure accurate and timely billing of claims, review of denials, adjustments, and write-offs and monitor accounts receivable balances to ensure compliance with TrueCare goals. The Back-End RC Manager will also work collaboratively with Finance and Operations leaders to maximize revenues and Medical Staff Office credentialing to ensure providers are properly enrolled in health plans.

Duties & Responsibilities:

• Manage the day-to-day operations of the RC department by providing direction, scheduling assignments, coordinating workflow, and assigning priorities.
• Develop training and performance standards and measures consistent with industry healthcare standards and ensure achievement of goals.
• Provide oversight of the billing cycle to maximize revenue and manage accounts receivable balances.
• Establish, implement, and provide direct oversight of departmental productivity standards ensuring accurate and timely submission of all claims to maximize potential revenue.
• Develop and implement feedback mechanisms for resolution of most frequent/costly denials in a timely fashion to improve billing efficiencies and cash flow.
• Ensure timely billing and collection of all Program Income, including Federal and State agencies, insurance companies, patients, and other third-party payers.
• Implement and maintain systems to audit billing submissions, payment posting, collections, denials, and adjustments including write-offs to ensure accuracy of accounts receivable, timely claims adjudication, and revenue maximization.
• Operationalize coding changes, program updates, and regulatory changes organization-wide, including RC, practice management (system and key players), and clinical operations.
• Assist, as needed, with billing/audit questions, ambulatory inquiries, education, database maintenance, statistical analysis, and processing of reviews of internal audits.
• Develop reports and analysis, as needed, to monitor revenue, quality, quantity, timely submissions, coding compliance, and general billing standards to meet Federal, State, health plan, and local requirements.
• Analyze trends of coding, charges, collections, adjustments, write offs, and accounts receivable balances and make appropriate changes to align staff and maximize revenue.
• In collaboration with the Revenue Cycle Director, ensure health plan information is up to date.
• In collaboration with Medical Staff Office, ensure timely insurance plan enrollment for providers.
• Manage daily, monthly, and annual close processes including the distribution of system generated financial reports.
• Assist in assuring that all billing department policies and procedures are accurately documented on PolicyTech by providing the Revenue Cycle Director with changes as they are identified.
• Ensure implementation of all billing and coding plans, programs, and projects among the team.
• Maintain a working knowledge of departmental coding operations and act as an in-house expert on issues pertaining to specialty coding and reimbursement.
• Assist in the annual independent audit as related to Program Income and Accounts Receivable matters. Provide responses to all internal and external audits as well as compliance audits and issues.

Required Qualifications:

• Bachelor's degree from an accredited institution in business, healthcare administration, or a related field or an equivalent combination of education and professional experience in a related field.
• A minimum of two (2) years prior supervisory experience.
• A minimum of three (3) years of experience in healthcare operations, business, or administrative functions.
• Experience working in a community clinic or a Federally Qualified Health Center (FQHC).
• Knowledge of HIPAA privacy and security regulations.
• Working knowledge of CPT, ICD9 and ICD10 codes, third party payor reimbursement including community clinic or FQHC expertise, billing and insurance regulations, medical terminology, insurance benefits, and appeal processes.
• Knowledge of third-party billing and state and federal collection regulations.
• Experience with an electronic health record system.
• Proficiency in Microsoft Office suite products, including Outlook, Word, Excel, and PowerPoint.

Desired Qualifications:

• Management experience.
• Experience in an ambulatory setting, with medical billing and collections.
• A minimum of one professional coding or healthcare compliance certification (such as Certified Coding Specialist - Physician-based, Certified Professional Coder, Registered Health Information Administrator, or Registered Health Information Technician).
• Two to three years of coding experience.

Benefits:

• Competitive Compensation
• Competitive Time Off
• Low-cost health, dental, vision & life insurance
• Tuition Reimbursement, Employee Assistance program

The pay range for this role is $90,776 to $136,165 on an annual basis.