Manager of Revenue Cycle Management

Job Description: 

Introduction:

At EverTrue, team members at all levels find their calling in our mission of Older Adults Living Life to the Fullest. In this work environment, all team members are part of a community and appreciated by the people they work with – residents and coworkers – every day. 

Summary:

The Manager of Revenue Cycle Management (RCM) is responsible for management of the billing of third-party claims and related benefit verification process for all EverTrue residents billed through the Skilled Nursing Care Centers and our Home & Community Based Services (Anywhere Care) service lines.

Essential Duties and Responsibilities:  

1. Manages and trains home office revenue cycle management team for billing skilled nursing facility (SNF) and Anywhere Care claims to Medicaid, Medicare, Managed Care and Commercial Insurance companies via electronic claims submission for multiple sites

2. Manages billing team’s adherence to corporate compliance plan and related policies

3. Ensures compliance to all government reporting from a reimbursement perspective (e.g., credit balance reports, bad debt schedules for cost reporting)

4. Oversees Accounts Receivable (AR) collections and related monthly bad debt allowance analysis for Medicaid, Medicare, Managed Care, and Insurance AR; Reviews AR monthly and follows up with team as necessary to support their collection efforts; Meets with the Director of Revenue Cycle Management as needed/requested to monitor AR benchmarking statistics (days in AR)

5. Oversees process to ensure all claim audits and appeals are responded to in a timely and thorough manner

6. Serves as a technical resource for complex reimbursement situations

7. Facilitates communications between billing team and community clinical (nursing and therapy) and medical records staff to ensure receipt of information needed for timely filing of all third-party claims

8. Coordinates with accounting, IT and the community business office managers regarding third-party billing functions/software systems

9. Coordinates with the Director of Revenue Cycle Management to develop, document, and implement processes and procedures related to third -party billing; Assists in the development and management of reimbursement-related policies

10. Maintains up-to-date technical knowledge of Payer billing rules and regulations via the CMS website, MAC website, newsletters, etc.

a. Ensures personal competency remains current with updates

b. Ensures proficiency of billing team through their own research utilizing the above tools or from updates from the Director of Revenue Cycle Management

11. Conducts research of Medicaid, Medicare, and Managed Care regulations as necessary related to the reimbursement aspects of new government initiatives effecting claims processing (e.g., ICD10 implementation, Bundled Payment and ACO initiatives)

12. Monitors billing software updates for changes related to third-party billing and develop and implement necessary processes to train team and implement all updates

13. Coordinates and promotes use of online tools as available for education, claims follow up and benefit verification

14. Supports the team and facilitate their role to serve as a resource to residents, community billing staff and EverTrue management for third party payer related issues

15. Develops and manages the process for verification of resident’s Medicare/Commercial Insurance benefits prior to receipt of third-party billable services

16. Supports EverTrue management and Senior Leadership by taking an active role by participating in special projects, strategic initiative planning, and committees where reimbursement expertise is needed

17. Hires, develops, manages, and coaches team members; Prepares and conducts performance appraisals

18. Oversees and supports RCM-related IT applications to ensure accurate revenue recognition, accounts receivable, compliant claim generation, and to maximize the timeliness of payments for services billed

19. Supports the Director of RCM with the preparation of provider enrollment and revalidation/recredentialling applications, including the collection of and uploading of necessary information; In some cases, completing applications for review by the Director of RCM

20. Supports the Director of RCM with the enrollment and maintenance of electronic funds transfers (EFT’s) and  electronic remittance advice (ERA’s) relating to all third-party payers

Knowledge, Skills, and Abilities:

5 years of Medicare & Medicaid billing experience including handling of complex billing issues

Strong knowledge of Medicare & Medicaid regulations and ability to research

Associate’s or Bachelor’s degree preferred

Strong written and oral communication skills

Detail oriented with ability to multi-task and prioritize

Ability to lead a team and manage relationships with team members, vendors and EverTrue management

Proficient computer skills including Microsoft Outlook, Excel and Word.

Physical Activities and Demands:

The physical activities and demands described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Lifting up to 30 pounds. Pushing/pulling 100 lbs. on wheels. A well-lighted and ventilated working area that has its own temperature control system (air conditioning and heat). The work will have some short notice requests, timelines for completion of tasks or reports and some major projects extending over months. Minimal exposure to infectious diseases and blood borne pathogens. Minimal exposure to chemicals and hazardous waste. Minimal exposure to outside weather conditions.

This job description in no way states or implies that these are the only duties to be performed by the employee assigned to this position. Employees may be required to follow other job-related instructions and to perform other job-related duties as requested, subject to all applicable federal, state, and local laws and standards.

Additional Information:

The Manager of Revenue Cycle Management (RCM) is responsible for management of the billing of third-party claims and related benefit verification process for all EverTrue residents billed through the Skilled Nursing Care Centers and our Home & Community Based Services (Anywhere Care) service lines.