Manager of Revenue Cycle

Indiana Health Centers, Inc.•Indianapolis, IN

About The Position

The Manager of Revenue Cycle is responsible for overseeing and optimizing the entire revenue cycle process at IHC, ensuring efficient, accurate, and compliant billing and collections. This position plays a critical role in sustaining the financial health of the organization by managing all aspects of revenue generation, reimbursement, and payment posting. The Manager of Revenue Cycle will work closely with clinical, administrative, and financial teams to enhance revenue performance, ensure compliance with federal and state regulations, and implement industry best practices. Under the general direction of the CFO, the Manager of Revenue Cycle is responsible for the management of third-party payor contracts (Managed Care Entities) and maintenance of all Accounts Receivable and Billing related record-keeping systems and involves a technical independence guided by administrative routines, requirements of others and established schedule. The position provides guidance of a functional nature to staff members directly involved with the IHC finance, both in the corporate office and at the sites. Position supervises the billing department staff. Working closely with IHC health center operations team and the IT department,, the Manager of Revenue Cycle participates as a member of a team who develops and implements, maintains, and evaluates corporate information systems.

Requirements

BA/BS degree from an accredited school with 3-5 years experience in third-party payor contract negotiations/management, medical billing and 3 years experience supervising non-exempt staff.
Requires expert knowledge of an extensive body of managed care contracting, medical billing and medical coding rules and regulations, specifically related to state Medicaid reimbursement – Healthy Indiana Program (HIP) and Medicaid Contract Offices (MCOs) and Medicare (CMS).
Requires knowledge of, precedents, procedures, and past practices applicable to medical billing and medical coding and cost recovery along with knowledge of IHC’s structure, goals, and specialized terminology.
Requires knowledge of CPT and ICD coding.
Requires knowledge of managed care and third-party payer contract negotiations including value-based terms.
Demonstrate near and mid-range planning skills
Anticipate and alert others to problems with projects or processes
Evaluate and monitor corporate strategic objectives
Demonstrate analytical problem solving, decision-making, and trend analysis skills
Draw evidenced-based conclusions; recommend and implement evidenced-based solutions
Perform necessary mathematical calculations
Organize a variety of statistical figures
Collaborate with clinical and administrative teams to enhance workflows that impact the revenue cycle, such as registration, scheduling, and documentation
Demonstrate effective verbal and written communication with a multidisciplinary team
Maintain effective working relationships with management team and other staff
Read, understand, organize, and effectively explain complex, financial and statistical data
Demonstrate knowledge of accounting principles and methods
Demonstrate knowledge of ICD and CPT coding.
Apply recent regulations/guidelines on non-profit, health care billing and revenue
Understand, interpret, and prepare financial reports
Prepare detailed, organized, and accurate work product; consistently meet deadlines
Manage the medical billing/accounts receivable department
Demonstrate effective supervisory skills: recruiting, mentoring, disciplining, and developing
Develop high performing teams; maintain a team approach to problem solving & workflow
Prioritize tasks and time; follow up with subordinates, superiors, and co-workers
Make decisions and judgments that are demanding and interpretive; tolerates ambiguity
Plan and organize work with minimal supervision

Nice To Haves

Experience may be substituted for education.
Experience with MCOs and/or FQHCs preferred.

Responsibilities

Implement and manage third-party contracts
Monitor third-party contracts
Analyze data to determine rates for contract negotiations
Work with CFO to negotiate new and renewal contracts
Evaluate payor rate proposals
Review contracts ensuring terms are agreed by all parties
Work with CFO to terminate contracts, as needed
Maintain and update as needed detailed contract profiles, including key terms
Meet as necessary with CFO and/or CEO regarding contract updates/status
Guide internal resolution to payor issues, including under payment
Completion of all 2nd and 3rd party requests for payments forms
Preparation of all data input forms for the accounts receivable
Manages accounts receivables and past due accounts
Conducts monthly, quarterly, and annual AR “scrub”
Manages provider credentialing, privileging, and MCO panel award, includes working with IHC’s Credentialing Specialist and enrollment vendor
Compiles information for periodic financial reports
Assists the CFO on special projects as needed
Analyzes and presents data in a format conducive to decision-making by IHC managers
Identifies and develops measuring tools for corporate strategic objectives
Assists with the identification of data trends.
Assists management with the use of information sources
Supervises billing department staff—reviews work and evaluates performance.
Ensures knowledge advancement and professional development of billing personnel
Assists CFO in establishment and oversight of internal controls for AR/billing
Prepares required reports as directed by the CFO
Develop and implement policies and procedures to streamline revenue cycle processes, reduce errors, and increase efficiency
Analyze revenue cycle workflows to identify opportunities for improvement and recommend and implement changes that maximize revenue and improve the patient experience.