CAS Revenue Cycle Manager

Genesis Healthcare System•Zanesville, OH

22h

About The Position

Manages and directly participates in the performance of the revenue cycle operations of Community Ambulance Service (CAS) to maintain a high functioning revenue cycle. Plans, organizes, and directs overall operations of revenue cycle functions. Manages and directly supervises daily operations of the billing, follow up and denial processes. Determines work schedules, monitors performance, resolves technical and project issues and educates staff.

Requirements

Bachelor’s degree in business or other related field. Must be completed within 24 months of role acceptance.
Must have a minimum of five (5) years’ experience performing similar work.
Demonstrates a broad base knowledge in the areas of patient registration, billing, accounts receivable and cash management, managed care contractual terms, financial reporting, and industry standards for healthcare revenue cycle management practices.
Ability to lead and manage diverse staff in a learning environment with frequent changes in departmental priorities. Ability to recognize necessary changes in priority of tasks and allocation of resources, and act upon them as required to meet workload balance.
Superior management skills that emphasize team building with the ability to provide clear direction to the department, while also functioning as an individual contributor. High level of initiative, drive and poise coupled with qualities of maturity, professionalism, flexibility, and patience.
Ability to interpret 3rd party payer contract requirements and recommend, design and implement procedures for compliance with regulations and standards. Ability to negotiate with insurance vendors, medical directors, and 3rd party payers when appropriate in order to facilitate the denial management process.
Ability to communicate and work with physicians, physician office personnel, associates, case managers, 3rd party payer review personnel, and others in order to expedite the revenue cycle processes to avoid negative financial impact on GMG.
Excellent communication skills (verbal and written), conflict management and strong facilitation and consensus building skills in dealing with various internal/external customers.
Demonstrates the ability to be a collaborator, a team player and a capable influencer and motivator; to think creatively and conceptualize innovative solutions to business problems. Must be able to act as a change agent/leader, coach, and mentor in order to secure buy-in and break down barriers.
Must be able to set and organize own work priorities, and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others.

Responsibilities

Oversees all revenue cycle activities through relationships with managers, office and billing staff, and other support staff within revenue cycle process. Coordinates revenue cycle interaction with the operations and revenue producing areas.
Responsible for the oversight, development, and implementation of strategy and tactical aspects of claims, appeals management, financial assistance and payment posting processes.
Analyzes CMS memorandums and payor reimbursement methodologies (Commercial and Government). Performs research reviews of process changes associated with new regulations and implements a compliant process for the system.
Analyzes daily financial data to determine areas of leakage and partners with departments to optimize collections and improve the capture of compliant charges. Performs root cause analyses with trends to share with appropriate leaders.
Monitors and maintains receivables, days outstanding in account receivables to maintain cash flow and optimize collections.
Maintains billing system and edits to assure compliance to billing and regulatory requirements. Works with third party payors, handles patient complaints, conducts employee training and performance evaluations.
Liaison to all hospital departments as it relates to EMS billing, coding, denials, payor contracts, and CMS coverage guidelines.
Develops, produces, and reviews the Performance Indicator Report, or other similar performance reports within Zoll Billing, with administration, Senior Leadership & the CAS Board. Demonstrate revenue cycle performance and comparisons to targets and benchmarks.
Works collaboratively with managers to ensure that staff capture and report accurate billing information and follow revenue cycle related policies, such as collection of co-pays/ABNs, treatment of self-pay balances, and appropriate charity care designation.
Oversees training/education in relation to all aspects of the revenue cycle process through the collections and reimbursement process.
Analyzes trending and secures process improvements consistent operational improvements in account resolution.
Oversees the denial management process, including working with billing and denial staff to track and trend recoveries, and to ensure appropriate communication and follow-up activities. Is the POC for all 3rd party agencies (Collections).
Works with systems partners to monitor and coordinate responses to the latest regulatory billing/payment requirements of the federal, state and 3rd party payers to ensure CAS is in compliance and that electronic data processing (EDP) systems and coding structures are maintained to minimize manual processing and maximize claims acceptance and reimbursement. Translates regulatory requirements into daily operational procedures. Expedites payment processing and resolves problems with major 3rd party payers.
Maintains compliance with applicable federal, state, and local laws and regulations, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
Researches and understands Regulatory requirements and maintains a consistent knowledge of payer changes, Governmental changes and/or billing requirements to ensure Genesis captures and is reimbursed correctly for all services provided.
Ensures all Medicare, Medicaid, and Commercial, guidelines are accurately administered for Genesis.
Prepares required reports using statistically sound information, displaying content in easily understandable format.
Secures data for month end scorecard metrics and builds action plans to meet and exceed targets.
Conducts team meetings for enhanced communication within Professional and Hospital patient accounts.
All other duties as assigned.