Manager of Revenue Cycle Management - Remote (US)

Theoria Medical Overview

Theoria Medical is a comprehensive medical group and technology company focused on improving healthcare delivery through post-acute care and primary care services. They serve facilities across the United States with a variety of services including multispecialty physician services, telemedicine, and remote patient monitoring.

Essential Functions and Responsibilities

• Lead and manage revenue cycle operations, including billing, holds/credentialing, denials, collections, and accounts receivable management.
• Assist in developing and implementing KPIs and policies and procedures to ensure accurate and timely submission of claims, reduce denials, and increase collections.
• Analyze trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff, third party vendors and revise policies and procedures.
• Identify and resolve revenue cycle issues, including coding and billing errors, incomplete or inaccurate patient information, insurance prioritization and other issues that may impact revenue.
• Monitor and analyze revenue cycle metrics, including accounts receivable aging, claim submission, payment turnaround times, and denial rates.
• Analyze billing and claims for accuracy and completeness; follow up with RCM teams and third party vendors on work queues, pending claims and unpaid AR.
• Spearhead the resolution of rejected or underpaid claims by conducting targeted appeals and payer negotiations.
• Analyze and manage overpayments from payers as well as implementing policies to reduce denials and refunds.
• Work with credentialing, billing and coding staff to ensure compliance with regulatory requirements, including HIPAA and other federal and state regulations.
• Work closely with the RCM Directors to supervise, mentor, and evaluate offshore RCM teams and third party vendors.
• Develop and maintain strong relationships with RCM Directors, HR, Clinical Operations and Credentialing departments to ensure a smooth revenue cycle operation.
• Review and respond to various payor correspondence
• Communicate with patients and clients

Requirements and Qualifications

• 7+ years of experience in revenue cycle management in a healthcare setting
• Advanced knowledge of the healthcare industry and a strong financial background
• Clear understanding of billing and collection regulatory guidelines and requirements
• Vast CPT and ICD-10 expertise
• Vast knowledge in credentialing and payor management
• Proficient background in reimbursements
• Experience in monitoring clearinghouse activity, reports, and processes
• Experience in setting up payors with EDI, ERA, and EFT processes
• Experience in managing and leading a team of revenue cycle professionals
• Strong analytical skills and attention to detail
• Excellent communication and interpersonal skills
• Ability to work in a fast-paced environment and manage multiple projects simultaneously
• Agility, strong leadership, problem-solving skills
• Ability to maintain up-to-date knowledge of technology and software including but not limited to Monday, Slack, Google suite of Applications, spreadsheets (Excel), Zoom, MS Teams, eClinicalWorks

Physical Requirements

• Must be punctual or on time and adhere to the company's Time and Attendance policy.
• Must be able to remain sitting for the majority of their shift.

Compensation and Benefits

• Competitive Compensation
• 401k with Employer Match
• Health, Dental, and Vision Insurance
• PTO and Holiday Pay
• Employer Paid Life insurance Policy
• Short and Long-Term Disability Insurance
• Company Provided Equipment
• Employee Assistance Program (EAP)