Manager, Revenue Cycle Operations - Zero Balance Review

Job Summary:

The Zero Balance Review (ZBR) Manager leads the operational execution, performance management, and financial outcomes of a hospital revenue cycle program focused on identifying and recovering additional reimbursement from accounts that have reached a zero balance.

Key Responsibilities:

1. Zero Balance:
   1. Evaluate account-level reimbursement opportunities and develop targeted recovery strategies.
   2. Manage production teams to ensure timely execution, quality outcomes, and measurable financial performance.
   3. Identify missed reimbursement opportunities, inappropriate contractual adjustments, and other payment discrepancies that may not have been detected during initial accounts receivable or denial management processes
2. Leadership:
   1. Provide leadership and direction to the revenue cycle team, including billing, coding, claims, collections, and payment posting staff.
   2. Recruit, train, and develop team members to ensure high performance and professional growth.
   3. Conduct regular performance evaluations and provide feedback and coaching to team members. 
3. Revenue Cycle Optimization:
   1. Develop and implement strategies to improve revenue cycle processes and increase efficiency.
   2. Monitor key performance indicators (KPIs) and develop action plans to address areas of improvement.
   3. Utilize data analytics to identify trends, issues, and opportunities for revenue enhancement.
4. Claims Management:
   1. Manage the claims submission process, including electronic and paper claims.
   2. Monitor claim denials and rejections and develop strategies to reduce denial rates.
   3. Work with payers to resolve claim issues and ensure timely reimbursement.
5. Collections and Payment Posting:
   1. Oversee the collections process to ensure timely and accurate patient payments.
   2. Develop and implement policies and procedures for payment posting and reconciliation.
   3. Manage patient accounts and resolve billing inquiries and disputes.
6. Compliance and Regulations:
   1. Ensure compliance with federal, state, and local regulations, including HIPAA and other healthcare laws.
   2. Stay updated on changes in healthcare regulations and payer requirements.
   3. Implement and enforce policies and procedures to maintain compliance.
7. Reporting and Analytics:
   1. Prepare and present regular reports on revenue cycle performance to senior management.
   2. Utilize data analytics to identify trends, issues, and opportunities for improvement.
   3. Develop and implement dashboards and other tools to monitor revenue cycle metrics.
8. All Other Duties as Assigned

Qualifications:

Required Expertise

1. Hospital billing and revenue cycle operations
2. Payer reimbursement methodologies and claim adjudication
3. Contractual payment terms, underpayment review, and insurance follow-up

General Qualifications:

1. Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or related field. Master’s degree preferred.
2. Minimum of 5 years of experience in revenue cycle management, with at least 2 years in a supervisory or managerial role.
3. Strong knowledge of healthcare billing, coding, claims processing, and collections.
4. Familiarity with healthcare regulations, including HIPAA and payer requirements.
5. Proficiency in revenue cycle management software and electronic health record (EHR) systems.
6. Excellent leadership, communication, and interpersonal skills.
7. Strong analytical and problem-solving abilities.

Ability to work in a fast-paced and dynamic environment.

Health Business Solutions (HBiz) is an Equal Opportunity Employer. We are committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law.

HBiz complies with all applicable employment laws for remote and multi-state hiring and provides reasonable accommodations as required by law.