Revenue Cycle Manager/ Pre-Certification

Employment Type: Full-Time
Location: Teaneck, NJ - Remote
Compensation: $81,685 - $85,000 annual

Responsibilities

• Oversee the Eligibility and Pre-authorization teams for Oncology treatments and oral pharmacy services, ensuring all patient eligibility is verified accurately and promptly.
• Function as a liaison between Central Business Office, physicians, and practice sites to resolve accounts receivable issues and questions.
• Develop and maintain relationships with insurance providers to facilitate efficient eligibility verification processes and pre-authorization submissions.
• Collaborate with healthcare providers to gather necessary documentation required for pre-authorization and ensure timely approval of oncology treatments and oral pharmacy prescriptions.
• Implement and oversee technology solutions to streamline eligibility checks, pre-authorization processes, and reduce manual errors.
• Monitor and report on pre-authorization approval rates and turnaround times, identifying areas for improvement.
• Coordinate with the billing department to ensure that pre-authorized treatments are billed correctly and in a timely manner.
• Conduct regular audits to ensure adherence to internal policies and external regulations, staying informed about changes in healthcare regulations related to oncology and pharmacy services.
• Assist in the development and implementation of training programs for corporate and practice employees, including training on eligibility and pre-authorization procedures, to improve A/R and billing functions.
• Maintain a working knowledge of applicable laws and regulations as they relate to assigned responsibilities and communicate regulatory and industry standards to employees.
• Conduct audits to ensure compliance and monitor productivity in the A/R, eligibility, and pre-authorization functions.
• May coordinate facilities and office management functions including payroll submission.
• Supervise, through multiple subordinate supervisors, teams of employees involved in the Pre-authorization and eligibility of Accounts Receivable for the Central Business Office.
• Provide on-going front-office process review and implement process revisions as needed.
• Coordinate and/or provide training for new front office staff, and retraining as needed.
• Serve as Super User of Practice Management System and interfaced systems.
• Ensure roll-out of System updates to front-office team.
• Chair Revenue Cycle Front Office task teams.
• Co-chair C2C.

Requirements

• High school diploma or equivalent required; Bachelor’s degree preferred.
• Oncology experience preferred.
• Minimum seven years of medical business office experience.
• Two years experience managing, delegating, and following up on work priorities of others.
• Strong knowledge of medical insurance billing and collections with CPT, ICD9, and HCPC coding and medical terminology, as well as an overall understanding of managed care products (HMO, PPO, etc).
• Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint).

Benefits

• Health, dental, and vision plans
• Wellness program
• Health savings account
• Flexible spending accounts
• 401(k) retirement plan
• Life insurance
• Short-term disability insurance
• Long-term disability insurance
• Employee Assistance Program (EAP)
• Paid Time Off (PTO) and holiday pay
• Tuition discounts with numerous universities

Physical Demands

• The employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear.
• Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination.
• Requires standing and walking for extensive periods of time.
• Occasionally lifts and carries items weighing up to 40 lbs.
• Requires corrected vision and hearing to normal range.

Work Environment

• The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment.
• Work will involve in-person interaction with co-workers and management and/or clients.
• Work may require minimal travel by automobile to office sites.