Manager of Revenue Cycle Management - Remote (US)

Theoria Medical•Novi, MI

6h•Remote

About The Position

Theoria’s Finance Department is seeking individuals to join its team to oversee and optimize the revenue cycle operations of our physician group. The Revenue Cycle Manager will be responsible for managing the billing and collections processes, ensuring accurate and timely submission of claims, and resolving any revenue cycle issues that arise. The candidate must have extensive experience in healthcare revenue cycle management, strong leadership and communication skills, and a commitment to maximizing revenue while minimizing operational costs.

Requirements

7+ years of experience in revenue cycle management in a healthcare setting
Advanced knowledge of the healthcare industry and a strong financial background
Clear understanding of billing and collection regulatory guidelines and requirements
Vast CPT and ICD-10 expertise
Vast knowledge in credentialing and payor management
Proficient background in reimbursements
Experience in monitoring clearinghouse activity, reports, and processes
Experience in setting up payors with EDI, ERA, and EFT processes
Experience in managing and leading a team of revenue cycle professionals
Strong analytical skills and attention to detail
Excellent communication and interpersonal skills
Ability to work in a fast-paced environment and manage multiple projects simultaneously
Agility, strong leadership, problem-solving skills
Ability to maintain up-to-date knowledge of technology and software including but not limited to Monday, Slack, Google suite of Applications, spreadsheets (Excel), Zoom, MS Teams, eClinicalWorks

Responsibilities

Lead and manage the revenue cycle operations, including but not limited to billing, holds/credentialing, denials, collections, and accounts receivable management.
Assist in developing and implementing KPIs and policies and procedures to ensure accurate and timely submission of claims, reduce denials, and increase collections.
Analyze trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff, third party vendors and revise policies and procedures.
Identify and resolve revenue cycle issues, including coding and billing errors, incomplete or inaccurate patient information, insurance prioritization and other issues that may impact revenue.
Monitor and analyze revenue cycle metrics, including accounts receivable aging, claim submission, payment turnaround times, and denial rates.
Analyze billing and claims for accuracy and completeness; follow up with RCM teams and third party vendors on work queues, pending claims and unpaid AR.
Spearhead the resolution of rejected or underpaid claims by conducting targeted appeals and payer negotiations.
Analyze and manage overpayments from payers as well as implementing policies to reduce denials and refunds.
Work with credentialing, billing and coding staff to ensure compliance with regulatory requirements, including HIPAA and other federal and state regulations.
Work closely with the RCM Directors to supervise, mentor, and evaluate offshore RCM teams and third party vendors.
Develop and maintain strong relationships with RCM Directors, HR, Clinical Operations and Credentialing departments to ensure a smooth revenue cycle operation.
Review and respond to various payor correspondence.
Communicate with patients and clients.