Medical Accounts Receivable Manager

About the role

The position is aimed at maximizing institutional, professional, pharmacy, and dental revenue through effective collection and cash posting processes. It involves managing, providing technical direction, understanding process management, and motivating teams.

Responsibilities

• Manages and leads the accounts receivable and cash posting functions and staff in the area of medical (Institutional & Professional), Pharmacy and Dental, follow-up, claims’ appeals, denied claims resolution, cash posting, and contractual adjustments.
• Supervises 10 or more employees in revenue integrity and billing compliance reviews to identify reimbursement opportunities, coding accuracy issues, billing vulnerabilities, and regulatory risks.
• Conducts and oversees audits involving claims submission, coding accuracy, medical necessity, documentation support, payer compliance, charge capture, and reimbursement integrity.
• Performs trend analysis of denials, underpayments, payment variances, and aged AR to identify root causes and implement corrective actions.
• Partners with HIM, Coding, CDI, Compliance, and Clinical Operations to improve documentation quality, coding accuracy, and reimbursement performance.
• Develops, implements, and maintains accounts receivable and cash posting policies and procedures.
• Coordinates and oversees work of staff; distributes workloads as necessary.
• Maintains time and attendance in timekeeping system of staff.
• Maintains productivity of staff to ensure it meets production standards.
• Ensures staff is provided a work environment conducive to productivity and good health.
• Trains employees and holds periodic (in-house) training sessions.
• Verifies accuracy of services and billed amount.

Requirements

• Education: Associate’s Degree in Business Administration or related business field (Finance, Accounting, Administration, etc.) or an equivalent to 18 months of experience.
• Experience: Minimum three-years of successful supervisory or management experience. Minimum five-year experience as a medical coding, medical billing or accounts receivable technician in a tribal or non-profit healthcare patient accounting setting.
• Knowledge: Knowledge of CMS, OIG, Medicare, Medicaid, and commercial payer billing regulations.
• Skills: Demonstrated knowledge of ICD-9 and ICD-10, and CPT/HCPCS coding/billing procedures, Uniform Hospital Discharge Data definitions regarding diagnostic and procedural sequencing in order to interpret and resolve problems based on information derived from system monitoring reports and the UB-04, HCFA-1500, and ADA billing forms submitted to the third-party payer.

Qualifications

• License/Certification: Obtain a Certification as a Revenue Cycle Representative through the Healthcare Financial Management Association (HFMA) one year from date of hire.
• Other Skills And Abilities: A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas: Positive working relationships with others, Possession of high ethical standards and no history of complaints, Reliable and dependable; reports to work as scheduled without excessive absences and no reported attendance issues, Ability to access and use multiple data systems, Ability to plan and lead effective team meetings and training, Possess expertise in professional communication, interpersonal, organizational leadership and team building skills, Possess excellent customer services skills for internal and external customers, Ability to work under pressure and making quality and effective decisions, Ability to positively motivate individuals and teams to meet or exceed department expectations/goals, Completion of and, above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job, Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job, Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job, Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC.

Benefits

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Pay

Details about pay are not specified in the job description.

Schedule

Details about the schedule are not specified in the job description.