Manager, Revenue Cycle Operations

Wellstar Health System•Dallas, GA

About The Position

Under the direction of the Assistant Vice President of Revenue Cycle Operations, the Manager, Revenue Cycle Operations oversees accounts receivable and revenue cycle operations for Wellstar Health System hospitals. The manager leads staff and vendor teams, monitors financial and operational performance, supports reimbursement and denial management, and coordinates with hospital and shared-services stakeholders to improve claims quality, cash performance, and revenue cycle processes. The role requires extensive knowledge of billing, collections, technical denial appeals and corrections, payer escalation requirements, data analysis, project management, and common business applications. The manager reviews revenue cycle performance against key indicators, supports month-end reporting and analysis, investigates variances affecting cash, accounts receivable, denials, and net revenue, and ensures work queues and reports are handled appropriately. The position also leads denial-related meetings and improvement initiatives, resolves operational and patient-account issues, maintains effective relationships across departments and with vendors, and ensures appropriate documentation and compliance with applicable policies and regulations. The role reports to the Assistant Vice President of Revenue Cycle Operations.

Requirements

High school diploma or GED required.
Minimum 10 years of experience in hospital healthcare, claims processing management, collections, or another management role in a healthcare environment; hospital healthcare experience is preferred.
Supervisory experience is preferred; the posting also specifies a minimum of 10 years of commensurate related experience including supervisory experience without a bachelor's degree.
Ability to establish a climate for optimal performance and maintain a cohesive work team.
Proficiency reading UB-04 forms.
Knowledge of technical payer appeal submissions, billing rules, and coverage requirements for major payers.
Ability to locate and review state and federal regulations relating to payers.
Ability to use major payer provider websites to investigate, correct, and resolve claims.
Ability to identify, analyze, and escalate technical denial trends and recommend revenue cycle improvements using reports and key performance indicators.
Ability to follow established escalation processes and time frames, resolve claims, and post adjustments during account review.
Ability to review staff productivity reports and identify opportunities for improvement.
Ability to create and update departmental policies and procedures.
Ability to work efficiently under pressure and handle constant change.
Ability to operate a computer and related applications, including MS Office, Excel, PowerPoint, Word, and Outlook.
Ability to apply supervisory, management, and leadership techniques; work independently, take initiative, continue learning, and accept or delegate responsibility.

Nice To Haves

Bachelor's degree in Business Administration or Management preferred.
Hospital healthcare experience preferred.
Supervisory experience preferred.

Responsibilities

Oversee accounts receivable and revenue cycle operations for Wellstar Health System hospitals.
Review revenue cycle performance against defined key performance indicators and targets.
Review financial class changes affecting reserves and monthly net revenue, and work with vendors and department leaders to explain variances.
Work with stakeholders to identify root causes of variances involving CFB, cash, accounts receivable, and denials.
Conduct revenue cycle and denial meetings; follow up with vendors on deliverables and drive process improvements.
Review, correct, escalate, or close technical denial accounts within payer time frames and document actions appropriately.
Assess daily work queues, including charge, CFB, and adjustment queues, to ensure timely account work.
Oversee daily reporting requests, including DNFB, CFB trending, accounts receivable, and other reports.
Serve as a denials contact for Case Coordination and Utilization Management, and as a liaison and escalation point for revenue cycle customer service issues.
Monitor and assist with CFB resolution and coordinate with PAS, AR, SBO, Coding, Compliance, vendors, and other stakeholders on revenue cycle metrics and account issues.
Analyze payer denial trends, fatal denial write-offs, and related improvement initiatives; report findings and facilitate monthly meetings.
Participate in facility meetings, including payer escalation, denial/disputes, utilization management, and complex case meetings.
Provide positive departmental leadership, promote cooperation and learning, and maintain effective communications with revenue cycle departments and other stakeholders.
Evaluate best-practice suggestions and support continuous improvement in revenue cycle processes.
Ensure staff follow up promptly on technical denial claims and remain accountable for aged receivables.
Conduct staff meetings, plan schedules, assign work, review and approve time and attendance, and ensure adequate service coverage.
Maintain and update departmental policies and procedures; approve technical denial and administrative write-offs in accordance with policy and audit staff write-offs.
Maintain an appeals toolkit and ensure appeals and supporting documentation are retained for audit and tracking purposes.
Resolve patient account and interdepartmental issues; analyze technical denial reports, identify trends and root causes, and communicate issues for upstream education.
Assist with departmental projects and presentations; participate in the Revenue Cycle Task Force and other assigned committees.
Maintain knowledge of HIPAA, debt collection guidelines, Medicare and Medicaid regulations, and applicable state and federal requirements; maintain appropriate compliance documentation and communicate with relevant agencies and representatives.
Lead vendor teams, implement Revenue Cycle applications, and lead work groups to improve department performance.
Comply with Wellstar policies, standards of work, and code of conduct, and perform other duties as assigned.