Accounts Receivable Manager

Pinnacle Healthcare Consulting LLC

1d•Hybrid

About The Position

Welcome to PINNACLE! Pinnacle Healthcare Revenue Solutions (PHRS) is a full Revenue Cycle Management (RCM) company focused on professional billing for independent physician practices. PHRS is a division of Pinnacle Healthcare, a growing healthcare consulting company based in Colorado with regional offices in St. Louis, Missouri, Indianapolis, Indiana, Phoenix, Arizona, and remote employees in 30+ states. We offer our employees a GREAT team environment, wonderful camaraderie, and a true appreciation & recognition for hard work.

Requirements

5 -10 years of experience in medical billing office or related environment.
Must have a thorough understanding of the entire revenue cycle including: customer service, charge entry, cash applications, accounts receivable, credentialing and coding.
Candidate must understand government and managed care payment methodologies and demonstrate knowledge of terms such as contractual adjustment, allowed amount, coinsurance, denial and denial processes.
Proven knowledge and ability to apply ICD10 and CPT Coding is a must.
Knowledge and ability to stay abreast of HIPAA laws and regulations and maintain compliance.
Attention to detail to ensure accuracy of information
Excellent MS Suite skills including Excel, Word, and Outlook
Proven analytical skills
Ability to present, communicate initiatives, results and analyses to multiple levels of management and clients
Current working knowledge in medical professional claims processing, payment posting, collections and A/R Follow up

Nice To Haves

Associates Degree in Medical Billing and Coding or a related field is preferred.

Responsibilities

Responsible for supervising assigned staff, including attendance, paid time off, payroll, training, corrective action and performance evaluations.
Ensures staff production, quality and compliance is maintained to company standards.
Ongoing motivation and training to staff.
Identify and resolve problems and inconsistencies and implement appropriate corrective procedures to resolve.
Functions as a liaison between upper management and position leads regarding revenue cycle issues.
Functions as a liaison between the client and associated client professional organizations, such as vendors, credentialing contacts, and other agencies as needed.
Is current on all payer bulletins and communicates pertinent information to staff, peers and management.
Prepares training material for all job functions, including PM system, payer portals, and any other internal and external resources required for the team to function at the highest level of proficiency.
Trains or instructs current and new employees in job duties or company policies or arrange for training to be provided.
Participates in the work of subordinates to facilitate productivity or to overcome difficult aspects of work.
Interprets and communicates work procedures and company and client policies to staff.
Resolves customer complaints or answers customers’ questions regarding policies and procedures that escalate from any department associate.
Makes recommendations to upper management concerning such issues as staffing decisions or procedural changes.
Recruits, interviews, and selects new employees with assistance from human resources.
Develops work schedules according to budgets and workloads.
Designs, implements, or evaluates staff training and development programs, customer service initiatives or performance measurement criteria.
Monitors staff for compliance of the organization’s confidentiality policy in accordance to the Health Insurance Portability and Accountability Act (HIPAA) regulations.
Completes all tasks assigned by the Director in a timely manner
Communicates any issues to the Director for tasks or other performance related that will extend a deadline or adversely affect revenue
Improve organizational performance by identifying opportunities for improvement in the revenue cycle process
Participates/Directs assigned general administrative projects.
Provides coverage for all areas in Accounts Receivable Department as needed; verifies insurance and obtain referrals/authorization for procedures; and monitors daily operating activity, making necessary adjustments in work assignments.
Daily/weekly/monthly report summary provided to specific personnel by management to review for current insurance eligibility verification and missing referral status.
Oversight and manage special projects given to eligibility and referral team.
Develop and implement new procedures to monitor and enhance productivity for both quality and quantity standards.
Effectively communicates policies to all team members and provides oversight that each team member is complying with company standards.
Consistently monitors client schedules for eligibility
Monitors work queue, and or other reports, for adverse activities or trends, and prioritizes work activity to correct
Perform Root Cause Analysis for denial trends and assist with process redesign to prevent/reduce avoidable denials
Communicate non-covered services to the Director for research and policy development
Monitor non-contractual adjustments for reason and to identify trends and appropriate action
Assure Account Receivable Specialists have access and training to perform task such as: Able to understand and articulate a payer’s explanation of benefits, Explain copayment and deductibles, Can accurately update patient demographics and insurance, Are able to refile a claim (based on the complexity of the account and payer)
Assure CSR have an assigned Accounts Receivable Specialists to promptly assist with complicated account resolution
Provide adequate CSR coverage consistent with the client’s time zone