Revenue Cycle Manager

Responsibilities

• Oversee all aspects of billing operations, including charge entry, claims submission, payment posting, and accounts receivable management.
• Monitor billing processes and workflows to ensure accuracy, efficiency, and compliance with billing regulations and payer requirements.
• Analyze revenue cycle metrics, key performance indicators (KPIs), and financial reports to identify trends, patterns, and areas for improvement.
• Develop and implement strategies to optimize revenue collection, reduce denials, and increase cash flow.
• Manage claims processing activities, including timely submission of clean claims and resolution of claim rejections and denials.
• Conduct root cause analysis of claim denials, identify trends, and implement corrective actions to prevent future denials.
• Monitor accounts receivable aging reports, analyze outstanding balances, and follow up on unpaid claims and patient balances.
• Implement strategies to reduce accounts receivable days, improve collections, and minimize bad debt write-offs.
• Maintain relationships with payers, insurance carriers, and third-party billing vendors to ensure accurate reimbursement and compliance with payer contracts.
• Negotiate payer contracts, fee schedules, and reimbursement rates to optimize revenue and minimize payment discrepancies.
• Ensure compliance with billing regulations, coding guidelines, and payer policies, including HIPAA regulations and CMS guidelines.
• Stay informed about changes in healthcare regulations, reimbursement policies, and coding updates affecting the revenue cycle process.
• Train and mentor revenue cycle staff on billing best practices, coding guidelines, payer requirements, and revenue cycle workflows.
• Provide ongoing education and support to staff to enhance their skills and performance.

Requirements

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field required; Master's degree preferred.
• Minimum of 5-7 years of experience in revenue cycle management, medical billing, or healthcare finance, preferably in a medical practice or healthcare organization.
• Strong leadership and management skills, with the ability to motivate and inspire staff to achieve revenue cycle goals and objectives.
• Expertise in healthcare billing and coding regulations, payer reimbursement methodologies, and revenue cycle processes.
• Proficiency in using revenue cycle management software, billing systems, and electronic health records (EHR) systems.
• Knowledge of healthcare compliance regulations, including HIPAA, CMS guidelines, and payer policies.
• Excellent analytical skills, with the ability to analyze data, identify trends, and implement strategies to optimize revenue.
• Strong communication and interpersonal skills, with the ability to interact effectively with staff, physicians, payers, and external stakeholders.