On Site - Revenue Cycle Manager

Hyndman Area Health Center

Bedford, Pennsylvania

Autofill and Review

27 days ago

Job Description

Responsive recruiter

Benefits:

Health insurance
Paid time off
Vision insurance
401(k)
401(k) matching
Dental insurance

Position Summary:

This position oversees the entire revenue cycle from claims processing and clearinghouse operations to A/R management, payer relations, compliance, and staff development. The Revenue Cycle Manager collaborates closely with clinical, operational, and administrative leadership to ensure timely and accurate billing, maximize reimbursement, and uphold high standards of compliance and service.

Essential Duties and Responsibilities:

Provides training and support for billing staff, credentialing team, providers and clinic managers.
Provides leadership and supervision to the following positions: Billing Supervisor and Credentialing Coordinator.
Collaborates with Front Office Supervisors/Manager regarding policies and procedures that affect the revenue cycle.
Works with the accounting team to ensure proper recording of patient revenue and related statistical data and analyzes and monitors billing trends.
Performs regular of agency billing practices, recommends and implements changes to policies and procedures as necessary.
Update and maintain the monthly RCM Dashboard and present monthly data to CFO.
Identify and implement a quality improvement initiative annually.
Maintain fee schedule for each service area.
Develop and implement policies and procedures to improve workflow efficiency and revenue integrity.
Serve as a point of contact for escalated patient billing concerns and payer issues.
Open cases with Practice Management vendor to troubleshoot and resolve issues as needed.
Attend internal and external meetings that pertain to Billing.
Continuously monitor Outstanding AR and address areas of concern.
Analyze and monitor Denial trends amongst various payers.
Analyze claims data and suggest/implement procedures to maximize HEDIS and incentive revenue collections (i.e., level II HCPCS codes, ICD-10 and CPT modifiers).
Perform billing analysis to ensure that the Billing Department is maximizing cash receipts.
Communicates issues that are preventing timely and accurate billings to CFO for performance improvement process.
Partner with managers to establish, implement, and refine front office protocols that support efficient revenue cycle operations
Ensure timely monthly close of the billing function.
Prepare and distribute end-of-month management reports.
Assist CFO with annual PA Medicaid cost reporting, audits, Medicare cost reports, HRSA reports/compliance/site visits, UDS, and other regulatory entities.
Reviews contracts to ensure contract fees are entered correctly, and routinely audits receipts to ensure payor compliance with contract terms
Supervise day-to-day revenue cycle operations, including charge capture, claim submission, denials management, payment posting, and patient collections.
Monitor key performance indicators (KPIs) such as days in A/R, denial rates, and collection percentages; identify trends and implement corrective actions.
Ensure compliance with all FQHC billing regulations, including Medicare, Medicaid, sliding fee schedules, and managed care requirements.
Review claims for accuracy and completeness prior to submission; oversee resolution of rejected or denied claims in a timely manner.
Coordinates Sliding Fee Discount Program.
Manage the configuration of all electronic billing systems to ensure proper functioning for effective and efficient billing and collection processes.
Establishes and maintains effective working relationships with external vendors, service providers, and internal finance staff to ensure accurate billing, timely claims processing, and efficient financial operations.
Serves as the primary liaison to resolve billing discrepancies, coordinate contract terms, and implement process improvements in partnership with the finance department.
Provide support and training to practitioners to ensure accurate, timely filing of claims
Ensure the timely submission of all claims for payment to third party payers.
Develop, implement and oversee procedures for the review, appeal and resubmission of all claim denials.
Manage the reconciliation of all discrepancies found in billing records in a timely manner, and provide reports to management or outside entities, as appropriate
Develop, implement and oversee procedures for the posting of all third-party payments received and the reconciliation of identified differences
Conduct quality assurance and accuracy audits of patient accounts
Must have the ability to work and travel between locations as needed.
Performs other duties as assigned by the CFO.

Qualifications

Associate’s degree in business administration, Health Care Administration, Finance or Accounting or related field preferred
Professional Coder Certification required.
At least 3 years of experience in medical billing/revenue cycle management, with 2+ years in a supervisory role.
Experience in a Federally Qualified Health Center (FQHC) or community health setting strongly preferred.
Working knowledge of ICD-10, and CDT coding
Proficient in analyzing revenue cycle metrics and driving process improvements.
Excellent leadership, analytical, and problem-solving skills.
Strong communication and interpersonal abilities to work effectively across departments.
Attention to detail with the ability to manage multiple priorities in a fast-paced environment
Understanding of Medicare and Medicaid billing rules and regulations for medical/behavioral health, vision, and dental
Knowledge of medical terminology
Proficiency in the use of Microsoft Office applications: Word, Excel, and Outlook
Experience and understanding of third-party reimbursement regulations and methods
Experienced in negotiation of medical costs with payers involves leveraging detailed cost reports and other data to secure favorable rates and terms, including those tied to Prospective Payment Systems (PPS).

Physical Requirements

Prolonged periods of sitting and working on a computer.
Ability to communicate effectively by phone, email, and in person.
Ability to occasionally lift and move office materials up to 20 pounds.

HAHC is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, sex, national origin, age, disability, genetic information, or any other status protected by federal, state, or local law.

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Numbers & Facts

Location

Bedford, Pennsylvania

Skills

Accountingunmatched
Accounting Closeunmatched
Accounts Receivableunmatched
Accounts Receivable Managementunmatched
Analysis Skillsunmatched
Behavioral Healthunmatched
Billingunmatched
Billing Recordsunmatched
Business Administrationunmatched
Charge Captureunmatched
Claims Processingunmatched
Communication Skillsunmatched
Community Healthunmatched
Configuration Managementunmatched
Contract Managementunmatched
Contract Reviewunmatched
Corrective Actionunmatched
Cost Reportingunmatched
Credit and Collectionsunmatched
Current Procedural Terminology (CPT)unmatched
Data Analysisunmatched
Denials Managementunmatched
Dental Insuranceunmatched
Detail Orientedunmatched
Executive Assistant Skills unmatched
Fee Scheduleunmatched
Financeunmatched
Financial Operationsunmatched
Head of Financeunmatched
Health Insuranceunmatched
Healthcare Administrationunmatched
Healthcare Common Procedure Coding System (HCPCS)unmatched
Healthcare Effectiveness Data and Information Set (HEDIS)unmatched
Healthcare Reimbursementunmatched
ICD-10unmatched
Identify Issuesunmatched
Interpersonal Skillsunmatched
Leadershipunmatched
Lift/Move 20 Poundsunmatched
Maintain Complianceunmatched
Managed Careunmatched
Material Movingunmatched
Medicaidunmatched
Medical Billingunmatched
Medical Terminologyunmatched
Medicareunmatched
Medicare Cost Reportsunmatched
Metricsunmatched
Microsoft Excelunmatched
Microsoft Officeunmatched
Microsoft Outlookunmatched
Microsoft Wordunmatched
Multitaskingunmatched
Negotiation Skillsunmatched
Office Managementunmatched
Organizational Skillsunmatched
Payment Postingunmatched
Performance Analysisunmatched
Performance Managementunmatched
Performance Metricsunmatched
Physical Demandsunmatched
Policy Developmentunmatched
Policy Implementationunmatched
Problem Solving Skillsunmatched
Procedure Developmentunmatched
Procedure Implementationunmatched
Process Improvementunmatched
Provider Credentialingunmatched
Quality Assuranceunmatched
Quality Managementunmatched
Reconciliationunmatched
Regulationsunmatched
Regulatory Complianceunmatched
Reimbursementunmatched
Reliability Centered Maintenanceunmatched
Reporting Dashboardsunmatched
Reporting Skillsunmatched
Requirements Managementunmatched
Revenue Analysisunmatched
Revenue Managementunmatched
Revenue/Sales Reportingunmatched
Staff Developmentunmatched
Statisticsunmatched
Team Playerunmatched
Third-Party Payerunmatched
Time Managementunmatched
Training/Teachingunmatched
Trend Analysisunmatched
Vendor/Supplier Relationsunmatched
Vision Planunmatched
Willing to Travelunmatched

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