RCM Manager

Veradigm•Raleigh, NC

4d•Hybrid

About The Position

Manages a RCM team who are responsible for all related medical billing activity for the purpose of maximizing accounts receivable collections for clients. In addition to performing similar work, the Manager will oversee and ensure group productivity and performance in accordance with financial goals to ensure the health of the client's Accounts Receivable Supports RCM Management by efficiently and effectively providing oversight and review of the team, processes and workload.

Requirements

Extensive knowledge with email, search engines, Internet
Ability to effectively use payer websites and LaserFiche
Intermediate practical knowledge and use of Microsoft products; Outlook, Word, Excel, PowerPoint
General knowledge of and the ability to learn/regularly use various billing systems, EMR’s and interfaces
Knowledge of CPT, ICD10 and modifiers.
Strong communication skills

Nice To Haves

Preferred experience with MS Access, Crystal reports
Previous experience with various billing systems, such as Next Gen, Pro, Allscripts, Epic and others
Accounting skills preferred
Experience in specialties such as Psychiatry, Internal Medicine, Orthopedics, General Surgery
Familiar with HMO and IPAs, Medicare Fee for Service Plans and Commercial Payers

Responsibilities

Responsible for staff productivity for follow-up of all unpaid, denied, and underpaid and overpaid claims. This includes but is not limited to: contacting insurance companies for claim status, reviewing all insurance claims and patient documentation, reviewing and ensuring appropriate coding, handling correspondence, and making appropriate decisions for follow-up action.
Must be effective at handling several accounts simultaneously and ensuring maximum accounts receivables and expedient collection turnaround for clients.
Meets with Client representatives to review billing progress, status of a accounts and review and resolve any issues presented by clients.
Ensures that staff and/or vendor, as applicable enters all charges into the medical billing system accurately and correctly for reimbursement. This includes but is not limited to: ensuring correct CPT codes, modifiers, and ICD codes, authorizations for services, patient demographics, and health insurance data.
Responsible for staff who enters all patient, insurance, and third party payments into the medical billing system. This includes a thorough knowledge and understanding of medical EOB’s, patient deductibles and co pays, and insurance or third party correspondence, contractual payments and adjustments.
Interact with clients and their patients, engage in proactive resolution of issues and timely response to questions and concerns.
Strong customer service skills for client satisfaction, health of client AR and management of RCM team members o answering client inquiries; prompt return and follow up to all interactions; prompt response to requests for information, both internally and externally o acts as primary point of contact for team members and provides guidance on work matters
Deliver timely required reports to the RCM Management; initiates and communicates the resolution of issues
Meet regularly with staff; in-person and as a group to confirm the status of client accounts and build/sustain staff engagement to drive business results and improvements
Track clients’ AR productivity and health (charge, payments, collections, adjustments) on a daily, weekly and/or monthly basis; as needed to ensure the client and company expectations are met
Remain current with company’s policies and procedures regarding AR activity such as, reviewing month end reports to insure the AR and cash collections are meeting agreed upon benchmarks, identifying trends, reviewing denial reports
Analyze reports to determine when, how and why decrease in clients’ AR; includes denials, unbilled, credit issues, holds; determine corrective actions and communicate with client and staff to resolve. Follow up to ensure actions are taken that achieve the results needed and/or determine other resolution needed
Review work performed by outside vendors for accuracy and production. Determine changes/improvement needed and works promptly and appropriate with applicable individuals to bring about such changes/improvement
Achieve goals set forth by management and compliance requirements
Follows, enforces and models adherence to all policies, procedures and processes