RCM Referral & Eligibility Manager

Pinnacle Healthcare Consulting LLC

About The Position

The Referral and Eligibility (R/E) Manager position oversees all eligibility verification and authorization procurement activities for all service lines of the client. The position is responsible for the team’s production and the completion of designated KPIs. This position has direct report responsibilities, including administrative, development and mentorship of staff.

Requirements

5 years of experience in revenue cycle management firm or billing office or medical practice
Proven experience with management of staff
Practicing knowledge of the entire revenue cycle including, intake, charge entry, accounts receivable, cash application, customer service, and credentialing
Demonstrate knowledge of government and managed care program as well as industry terms
Ability to maintain HIPAA as well as other compliance requirements
Proven analytical skills
Commitment to providing mentorship and development to staff
Interact with the client, practice staff, patient, or other in a professional manner
Works collaboratively with department managers, colleagues, staff, and leadership
Demonstrates ability to prioritize and manage multiple tasks

Responsibilities

Manage the R/E process to ensure that the avoidable denial percentages are within acceptable ranges
Review and interpret monthly denial reports to identify areas of opportunity
Monitor staff for compliance of the organization’s confidentiality policy in accordance with the Health Insurance Portability and Accountability Act (HIPAA) regulations
Seek opportunities for automation and/or disruption in the traditional methods to reduce denials that would positively impact department staffing budgets
Ensure staff production, quality and compliance is maintained to company standards by assigning tasks to staff and monitoring to ensure performance
Identify and resolve problems and inconsistencies and implement appropriate corrective procedures to resolve
Identify opportunities to build process and communication workflows with practice staff and/or management
Assess new client workflow to ensure R/E processes for all service lines are built and managed
Assist Revenue Optimization Specialist (ROS) for R/E in staying current on all payer bulletins and communicate pertinent information to staff
Works with ROS to design, implement or evaluate staff training and performance measurement criteria
Recruit, interview and select new employees with assistance from human resources
Responsible for supervising assigned staff, including attendance, paid time off, payroll, training, corrective action and performance evaluations
Develop work schedules according to budgets and workloads
Complete all tasks assigned by the Director in a timely manner