Collections Manager, Revenue Cycle Management

Atlantic Vision Partners•Richmond, VA

About The Position

As Collections Manager, you are responsible for effective and efficient accounts receivable management of assigned payers. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. These duties include management of staff, authorizing and reviewing all adjustments and refund requests, evaluating staff on-job performance, interviewing perspective new employees, hiring of new employees, morale building, training, establishing/maintaining policies and procedures for department, analyzing and maintaining A/R >90 days (about 3 months) at an acceptable level, and ensure all reports are worked within the established guidelines and time frames. The RCM Manager is also involved directly with collection efforts on outstanding accounts which include telephone contact with payers and parents, working collection reports, auditing accounts, appealing denied claims as necessary, updating accounts as necessary, submitting and monitoring problem packs, identifying carrier related denial trends, maintaining carrier issue logs on problem carriers and meet or exceed department goals. Performs required tasks in all relevant billing systems (including but not limited to Compulink, AdvancedMD, MDOffice, etc.), electronic claims verification systems and payer portals, Microsoft Office applications, and others.

Requirements

Associate degree (A. A.) or equivalent from two-year college or technical school; or three or more years related experience and/or training; or equivalent combination of education and experience.
Ability to read, analyze, and interpret common and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write speeches and articles for publication that conforms to prescribed style and format. Ability to effectively present information to top management, public groups, and/or boards of directors.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Willingness to submit to a background check

Responsibilities

Maintains and evaluates staff according to company policy and procedures.
Interviews and hires qualified employees.
Maintains staffing levels proportionate to the volume of accounts to preserve optimum efficiency and superior collections.
Discipline employees fairly and consistently, ensuring compliance with policy, procedures, and productivity standards.
Implement productivity standards and maintain reports identifying compliance breaches
Schedules staff work hours to ensure full coverage during normal work hours and distributes workflow to maximize efficiency.
Maintains logs on PTO requests, absences, tardiness, etc. along with approving hours worked.
Operates the department within the budget.
Approves overtime only when necessary and within the budget.
Works to minimize staff turnaround through good management and teamwork.
Manages the day-to-day operations within RCM.
Delegate and prioritize accounts to be worked.
Ensure all accounts are worked in a timely and efficient manner.
Provide guidance and training as necessary.
Encourages and maintains open communication with various departments to address issues,
Conduct regularly scheduled staff meetings.
Streamline workflow.
Review adjustment and refund request submitted by staff within a timely manner.
Review all adjustments and refund for accuracy at appropriate delegation of authority level
Forward all adjustments and refunds reviewed for Director approval in accordance with established thresholds
Completes monthly/daily reports that communicate the performance and progress of the department.
Evaluate staff on job performance.
Monitor work to ensure productivity standards are met.
Meet with staff at least monthly to discuss quality of work, productivity standards, attendance, and carrier issues.
Assist with yearly performance evaluation of employees.
Maintain, assist in the development of, and educate staff on department policy and procedures
Ensures and analyzes the performance of the employees on working the following reports timely and accurately:
Not Worked Report – Summarizes outstanding accounts not worked within the department’s guidelines.
Denial Report – Identifies specific denials posted from EOBs received.
Reject Report – Identifies specific denials for claims submitted electronically.
Reviews AR Reports weekly with Director and determines areas of concern to be distributed to RCM team to work
Analyze other management reports received from Regional Director.
Make the necessary telephone or written contact.
Contact payers to discuss carrier issues and solutions.
Contact parents to obtain accurate insurance information.
Phone appeals on denied claims.
Contact the Provider Representative to arrange for an in service.
Provide Call Center backup as needed.
Send appropriate letters.
Assist in coordination of collection audits on accounts when needed.
Review accounts for accuracy (i.e.; payments have been posted correctly, appropriate adjustments have been made, etc.).
Process refunds for overpayments made by payers and patients.
Process adjustments as necessary (i.e.; contractual, good faith, settlement, etc.).
Assist in appealing denied claims via mail or telephone.
Request Accounts Receivable Status Reports when a denial trend has been identified.
Review accounts receivable report detail for denial trends.
Obtain Medical Records from appropriate office locations and send them to the payer.
Review diagnosis and procedure codes with the appropriate clinical experts as needed
Review problem packs or appeals to specific payers.
Assist in updating accounts as necessary.
Update accounts in billing system with information obtained through correspondence and telephone (ie; insurance, authorization, address, name, etc.).
Corrects inaccurate information in accounts as needed, including but not limited to transfer of pre-pays and unapplied amounts posted to incorrect charge lines
Identify carrier related denial trends.
Review all available systems, reports, documents to identify denial trends
Resolve and/or bring problems to RCM Director.
Maintain carrier issue logs.
Records identified problems, A/R out to carrier, action(s), solution(s) and status.
Performs a variety of other management duties.
Manage various special projects.
Always meets deadlines, dates and times on assigned projects.
Obtains documentation in accordance with requests from auditors and submits to Accounting Manager in a timely manner
Assists with creating RCM goals; meets or exceeds required departmental goals consistently.
Meet goals specified in the monthly Collection Report
Maintain A/R greater than 90 days (about 3 months) at an acceptable level determined by management.
Reduce the number of days in outstanding A/R.
Ensure all accounts are working within the established timeframes and guidelines.
Maintain strict confidentiality.
Patient information must not be given on any account except to payers that need it to process the claim.
Any information relayed in confidence must not be divulged to any third party(s).
Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties.
Performs other job-related duties within the job scope as requested by RCM Director or additional escalated management.
Always embodies the principles of the corporate Mission Statement.
Represents the corporation in a positive fashion and makes all individuals feel as comfortable as possible.
Conducts all business professionally, maintaining respect for individuals.
Complies with departmental and company-wide policies and procedures.
Maintains constant awareness of potential safety hazards ensuring necessary safety precautions.
Reads and complies with established policies and procedures.