RCM Manager

About the role

Manages a Revenue Cycle Management (RCM) team responsible for all related medical billing activity to maximize accounts receivable collections for clients. The Manager oversees group productivity and performance to meet financial goals and ensure the health of clients’ Accounts Receivable. Supports RCM management by providing oversight and review of the team, processes, and workload.

Responsibilities

• Ensure staff productivity for follow-up of unpaid, denied, underpaid, and overpaid claims, including:
  • Contacting insurance companies for claim status
  • Reviewing all insurance claims and patient documentation
  • Ensuring appropriate coding and handling correspondence
  • Making decisions for follow-up actions
• Handle multiple accounts simultaneously to maximize accounts receivable and expedite collection turnaround
• Meet with client representatives to review billing progress, account status, and resolve issues
• Ensure accurate and correct entry of charges into the medical billing system for reimbursement, including:
  • Correct CPT codes, modifiers, and ICD codes
  • Authorizations for services
  • Patient demographics and health insurance data
• Oversee staff who enter patient, insurance, and third-party payments into the medical billing system, including:
  • Medical EOBs, patient deductibles and copays
  • Insurance or third-party correspondence, contractual payments, and adjustments
• Interact with clients and their patients to proactively resolve issues and respond to questions and concerns
• Provide strong customer service to ensure client satisfaction and the health of client AR
• Manage RCM team members by answering inquiries, following up promptly, and responding to requests for information
• Act as the primary point of contact for team members and provide guidance on work matters
• Deliver timely required reports to RCM management and initiate communication of issue resolutions
• Meet regularly with staff—both in-person and as a group—to confirm client account status and drive staff engagement and business improvements
• Track clients’ AR productivity and health (charge, payments, collections, adjustments) on a daily, weekly, and/or monthly basis to meet client and company expectations
• Stay current with company policies and procedures regarding AR activity, including:
  • Reviewing month-end reports to ensure AR and cash collections meet benchmarks
  • Identifying trends and reviewing denial reports
• Analyze reports to determine causes of decreases in clients’ AR (e.g., denials, unbilled, credit issues, holds) and determine corrective actions
• Communicate findings and resolutions with clients and staff, follow up to ensure actions achieve results, and determine additional resolutions as needed
• Review work performed by outside vendors for accuracy and production; identify needed changes/improvements and work with applicable individuals to implement them
• Achieve goals set by management and comply with compliance requirements
• Follow, enforce, and model adherence to all policies, procedures, and processes

Knowledge, Skills and Abilities

• Extensive knowledge of email, search engines, and the Internet
• Ability to effectively use payer websites and LaserFiche
• Intermediate practical knowledge of Microsoft products: Outlook, Word, Excel, PowerPoint
• Preferred experience with MS Access and Crystal Reports
• General knowledge of and ability to learn or regularly use various billing systems, EMRs, and interfaces
• Previous experience with billing systems such as NextGen, Pro, Allscripts, Epic, and others
• Preferred accounting skills
• Knowledge of CPT, ICD-10, and modifiers
• Experience in specialties such as Psychiatry, Internal Medicine, Orthopedics, General Surgery
• Familiarity with HMO and IPAs, Medicare Fee for Service Plans, and Commercial Payers
• Strong communication skills

Working Arrangements

Standard work week or as defined by assignment requirements. Primarily works in a standard office environment or remotely. May require after-hours, on-call support and/or holidays. On-call and after-hours work during peak times including end of month/quarter/year; during this time PTO is limited to meet business needs.