Manager of Revenue Cycle

Description Summary The Manager of Revenue Cycle is responsible for overseeing and optimizing the entire revenue cycle process at IHC, ensuring efficient, accurate, and compliant billing and collections. This position plays a critical role in sustaining the financial health of the organization by managing all aspects of revenue generation, reimbursement, and payment posting. The Manager of Revenue Cycle will work closely with clinical, administrative, and financial teams to enhance revenue performance, ensure compliance with federal and state regulations, and implement industry best practices. Under the general direction of the CFO, the Manager of Revenue Cycle is responsible for the management of third-party payor contracts (Managed Care Entities) and maintenance of all Accounts Receivable and Billing related record-keeping systems and involves a technical independence guided by administrative routines, requirements of others and established schedule. The position provides guidance of a functional nature to staff members directly involved with the IHC finance, both in the corporate office and at the sites. Position supervises the billing department staff. Working closely with IHC health center operations team and the IT department,, the Manager of Revenue Cycle participates as a member of a team who develops and implements, maintains, and evaluates corporate information systems. Evaluation of performance Performance will be evaluated based on meeting specific goals, productivity measures, employee satisfaction scores, and other quality indicators for this position such as: IHC strategic objectives; site strategic objectives; functional capabilities; leadership and/or employee capabilities; IHC commitments, quality measures, and productivity measures. Application of knowledge Requires expert knowledge of an extensive body of managed care contracting, medical billing and medical coding rules and regulations, specifically related to state Medicaid reimbursement – Healthy Indiana Program (HIP) and Medicaid Contract Offices (MCOs) and Medicare (CMS). Requires knowledge of, precedents, procedures, and past practices applicable to medical billing and medical coding and cost recovery along with knowledge of IHC’s structure, goals, and specialized terminology. Requires knowledge of CPT and ICD coding. Requires knowledge of managed care and third-party payer contract negotiations including value-based terms. Knowledge permits the employee to develop new approaches or improve current administrative operations within the confines of the laws and regulations. Third-party Payer Contract Negotiation/management Implement and manage third-party contractsMonitor third-party contractsAnalyze data to determine rates for contract negotiationsWork with CFO to negotiate new and renewal contractsEvaluate payor rate proposalsReview contracts ensuring terms are agreed by all partiesWork with CFO to terminate contracts, as neededMaintain and update as needed detailed contract profiles, including key termsMeet as necessary with CFO and/or CEO regarding contract updates/statusGuide internal resolution to payor issues, including under payment Medical Coding And Cost Recovery Completion of all 2nd and 3rd party requests for payments formsPreparation of all data input forms for the accounts receivableManages accounts receivables and past due accountsConducts monthly, quarterly, and annual AR “scrub”Manages provider credentialing, privileging, and MCO panel award, includes working with IHC’s Credentialing Specialist and enrollment vendor Information Management And Data Analysis Compiles information for periodic financial reportsAssists the CFO on special projects as neededAnalyzes and presents data in a format conducive to decision-making by IHC managersIdentifies and develops measuring tools for corporate strategic objectivesAssists with the identification of data trends.Assists management with the use of information sources Supervision and Coordination with CFO Supervises billing department staff—reviews work and evaluates performance.Ensures knowledge advancement and professional development of billing personnelAssists CFO in establishment and oversight of internal controls for AR/billingPrepares required reports as directed by the CFO Leadership –Able to: share compelling vision and direction; build strong, engaged, and empowered teams; drive and foster IHC mission, vision, and values; drive productivity and achieves result; follow standard problem-solving process; make data-driven, evidenced-based decisions; hold others accountable for performance Strategic Planning – Able To Demonstrate near and mid-range planning skillsAnticipate and alert others to problems with projects or processesEvaluate and monitor corporate strategic objectives Logic And Analysis – Able To Demonstrate analytical problem solving, decision-making, and trend analysis skillsDraw evidenced-based conclusions; recommend and implement evidenced-based solutionsPerform necessary mathematical calculationsOrganize a variety of statistical figures Communication – Able To Collaborate with clinical and administrative teams to enhance workflows that impact the revenue cycle, such as registration, scheduling, and documentationDemonstrate effective verbal and written communication with a multidisciplinary teamMaintain effective working relationships with management team and other staffRead, understand, organize, and effectively explain complex, financial and statistical data Medical Billing And Accounts Receivable – Able To Demonstrate knowledge of accounting principles and methodsDemonstrate knowledge of ICD and CPT codingApply recent regulations/guidelines on non-profit, health care billing and revenueUnderstand, interpret, and prepare financial reports Administration And Management – Able To Prepare detailed, organized, and accurate work product; consistently meet deadlinesManage the medical billing/accounts receivable departmentDemonstrate effective supervisory skills: recruiting, mentoring, disciplining, and developingDevelop high performing teams; maintain a team approach to problem solving & workflowPrioritize tasks and time; follow up with subordinates, superiors, and co-workersMake decisions and judgments that are demanding and interpretive; tolerates ambiguityPlan and organize work with minimal supervision Process Improvement And Optimization – Able To Develop and implement policies and procedures to streamline revenue cycle processes, reduce errors, and increase efficiencyAnalyze revenue cycle workflows to identify opportunities for improvement and recommend and implement changes that maximize revenue and improve the patient experience. Requirements BA/BS degree from an accredited school with 3-5 years experience in third-party payor contract negotiations/management, medical billing and 3 years experience supervising non-exempt staff.Experience may be substituted for education. Experience with MCOs and/or FQHCs preferred Equal Opportunity Employment Statement We are an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.