Medical Revenue Cycle Manager

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Team Leadership
  • Supervise and coordinate the workload of the billing staff to ensure all tasks are completed accurately and in a timely manner.
  • Define and communicate current and new billing tasks and definitions of the billing team.
  • Recommend and report billing issues of concern related to clinic operations.
  • Run, work and manage reports for the purpose of verifying quality and completeness of various data entry and other functions in the billing EMR system.
  • Communicate with FCCHC clinic staff about missing and erroneous data (impeding claim submission) and ensure the completion and correction of the same.
  • Work collaboratively with other members of the organization to maximize accuracy and completeness of patient claims and the promptness of the billing cycle.
  • Troubleshoot other problems in various billing processes and document to resolution problems discovered.
  • Maintain and control documentation of billing processes.
  • Execute quality controls processes to ensure consistent billing and collection.
  • Monitor third-party coverage contracts, ensuring that current contractual terms are understood and adopted correctly.
  • Absorb and implement process improvements.
• Billing Subject Matter Expert
  • Study and evaluate new and changing billing requirements and recommend solutions.
  • Work directly with providers and clinic operations to revise processes and resolve issues, if required.
  • Document significant billing changes and methods of management awareness.
  • Monitor changing standards and methods in billing to ensure FCCHC methods and processes are current.
• Organizing and Performing Other Tasks
  • Manage and coordinate the billing team's work results for quality, accuracy, and timeliness.
  • Oversee and review the transmission of patient claims in the EMR system and other electronic and paper claims processing.
  • Follow-up on unpaid claims with standard billing cycle time frame.
  • Oversee payment processing for accuracy and compliance.
  • Provide excellent customer service to patients inquiring about their accounts and process refund requests, if applicable.
  • Provide ongoing orientation and training to billing staff.

REQUIRED SKILLS AND ABILITIES

• Proficient in internet use and Microsoft Office, including Outlook, Word, and Excel.
• Strong attention to detail and ability to manage high volumes of work efficiently.
• Effective communicator with patients, insurance payors, and internal staff to resolve billing and claims issues.
• Excellent customer service skills for engaging with patients and families regarding medical and dental claims.
• Strong problem-solving skills to address discrepancies, denials, appeals, and collections.
• Ability to prioritize tasks, delegate when appropriate, and manage conflict constructively.
• Team-oriented with the ability to work independently and follow established policies and procedures.
• Demonstrated commitment to equity, inclusion, and respectful collaboration with diverse populations.
• In-depth knowledge of insurance guidelines (HMO/PPO, Medicare, Medicaid, etc.) and billing practices.
• Familiarity with CPT and ICD-10 coding; working knowledge of EMRs and billing systems.
• Certified coding certificate or equivalent experience required.

QUALIFICATION REQUIREMENTS

• Educational Requirement: High School diploma required. Associate's Degree in Medical Billing and Coding preferred or a combination of education and experience.
• Experience Requirement: Minimum of five years progressive billing experience required, including supervisory duties.

OTHER SKILLS AND ABILITIES

• Familiarity with effective use of computerized accounting/billing systems.
• Must be able to use other equipment such as a fax, copier and calculator.
• Good organizational skills and the ability to perform numerous tasks simultaneously in a fast-paced office environment.
• Good analytical skills, sticker for details, sense of personal responsibility for work performance and a professional attitude.
• The ability to work without constant supervision and adhere to policies and procedures is a must.

PHYSICAL/MENTAL DEMANDS

• While performing the duties of this job, the employee is regularly required to talk or hear, sit, and use hands to finger, handle, or feel objects, tools, or controls.
• The employee is occasionally required to stand, walk, climb, balance on two feet, stoop, kneel, crouch, or reach with hands and arms.
• The employee must occasionally lift and/or move up to 10 pounds.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Mental demands include the ability to learn, adapt to changes, pay close attention to details, exercise discretion and good judgment, develop options and solutions to crisis and problems, gather and analyze facts, courteous and professional behavior, deal with stressful situations and adhere to company policies and procedures.

WORK ENVIRONMENT

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
• The noise level in the work environment is usually moderate.