Revenue Cycle Lead

Primary Tasks/Responsibilities

• Performs advanced action and team support for RCM team functions including but not limited to coding, billing, collections, denials, AR aging, payment plans/options, and insurance benefits.
• Resolve high-dollar aged patient accounts, including insurance, self-pay, and mixed-coverage.
• Perform preliminary claim analysis to identify root causes of denials, underpayments, payment delays and other aspects of claims' processing impacting revenue.
• Ensure accuracy of team’s work including but not limited to posting of payments, adjustments, credits, and reconciliation in accordance with organizational policy.
• Serve as primary point for patients’ account resolution
• Perform and provide support to the team regarding denials prevention, appeal preparation, and payer follow-up.
• Support clean claim initiatives by validating documentation, coding alignment, and charge accuracy.
• Oversee processing and follow up of sliding fee discount program applications, recertification, and documentation and payment plans.
• Assist leadership with implementation of process improvement initiatives.
• Conduct workflow reviews, and quality assurance activities.

Education/Professional

• Minimum of 3 years of experience in Revenue Cycle.
• Demonstrated knowledge of medical billing, insurance verification, collections, denials, and AR workflows
• Experience working in FQHC, hospital, or large multi-specialty healthcare environment required.
• Revenue cycle certifications (CRCR, CHFP, CPC, or equivalent), preferred.

Knowledge, Skills and Competencies Required

• Strong understanding of Medicare, Medicaid, Florida managed care, and commercial payer requirements and systems
• Strong analytical, problem-solving, and critical thinking skills
• Excellent written and verbal communication skills
• High attention to detail and organizational skills
• Knowledge of sliding fee discount programs and patient financial assistance policies, preferred
• Familiarity with payer contracts and reimbursement methodologies
• Ability to quickly learn and work in EMR system- eClinicalWorks.
• Exceptional skills with Microsoft Office Suite programs- Excel knowledge necessary; SharePoint a plus
• Demonstrated ability to resolve patient financial concerns with professionalism and accuracy.
• Must be able to thrive in a busy environment with changing priorities.