Revenue Cycle Billing Manager (FHC)

About the role

Under the general direction of the Chief Financial Officer, this role manages the day-to-day supervision and processes associated with the medical billing function, including outsourced services, and ensures accurate and timely billing and collection of medical claims by monitoring and managing the Revenue Cycle Management (RCM) process.

Responsibilities

• Ensure billing and collection processes meet the organization’s financial and operational goals, as well as requirements for internal controls and third-party payors.
• Ensure billing and collection processes are compliant with state, local, and federal laws; regulations; and/or best practices.
• Review and oversee the weekly submission of Center for Medicare and Medicaid Services (CMS-1500) claims to appropriate health plans.
• Review claims denials for complexity and instruct staff to make corrections and resubmit claims within 30 days of denial received date.
• Perform quality control procedures on all claim forms and detail bills to ensure accurate billing.
• Verify insurance benefits and contact vendors regarding denials or benefit coverage.
• Run all required billing reports.
• Maintain appropriate staffing levels for RCM processes.
• Update annual clinic rate changes to Medicaid and Medicare Prospective Payment Systems.
• Develop and implement systems, mechanisms, controls, and reporting tools to monitor and ensure efficient billing and collection efforts.
• Develop and maintain positive working relationships with patients, contractors, vendors, third-party payor resources, and related entities.
• Perform fee schedule analysis, rate setting, and maintenance.
• Load and maintain procedure and diagnosis codes and perform related research as required.
• Research new technologies and tools, recommending improvements to existing processes and supporting ongoing improvement of billing and collection efforts.
• Research RCM clinical and grant programs to identify new programs or changes to existing programs.
• Assist administration in designing programs in the Practice Management Software (PMS).
• Supervise personnel, managing productivity, work assignments, and process improvement.
• Serve as a liaison for any outsourced RCM services.

Requirements

• Bachelor’s degree in Healthcare Administration, Business, Accounting, Finance, or a closely related field.
• Three years of management experience in revenue cycle management, including experience in billing and collections.

Physical Requirements and Working Conditions

• Responds to patient and FHC needs via telephone, internet, fax, computer software, and in person.
• Lifts and carries materials weighing up to 15 lbs.
• Spends extended periods of time sitting, typing, and reading computer screens.

Special Requirements

• Must be available to work extended hours, including before or after regularly scheduled hours and weekends, as necessary.
• Must provide own transportation to work at other locations as needed.

Benefits

• Medical, Dental, Vision
• Group Term Life
• Supplemental Life
• Accidental Death & Dismemberment
• Sick Leave
• Vacation
• Holiday Pay
• Bereavement Leave
• Kentucky Retirement Systems
• 457 Deferred Compensation
• Tuition Assistance