Revenue Cycle Manager

STARFISH FAMILY SERVICES INC•Inkster, MI

1d•Onsite

About The Position

The Revenue Cycle Manager is an essential member of a high performing management team who oversees client account activities, clinician/provider privileging and credentialing functions. The manager ensures the organization is compliant with local, state, and federal standards, policies, and guidelines. Work collaboratively to create and maintain a culture of excellence and dedication to providing compassionate and high-quality care to the people we serve and the community.

Requirements

Bachelor’s degree or higher in business, healthcare administration or another related field.
At least two (2) years’ previous experience in a supervisory or management capacity required.
Knowledge of general accounting principles and medical terminology.
Knowledge and understanding of state and federal rules and regulations regarding confidentiality, compliance, release of information, Fair Debt Collection practices, and insurance regulations.
Knowledge of principles and techniques used in negotiation as applied to service contracts and equipment purchasing.
Effective organizational, planning and project management abilities.
Experience in financial and programmatic presentations.
Demonstrated creativity and flexibility.
Ability to operate in high-pressure situations.
Demonstrated innovative approach to problem resolution.
Knowledge of ICD-10 Codes, CPT Codes, HCPCS Codes, Revenue Codes, and Place of Service Codes.
Experience working in Behavioral Health EHR system(s).
Intermediate level experience working in Microsoft Suite applications.
Knowledge of community mental health treatment programs and their continuum of care.
Knowledge of supervisory principles and practices including personnel and systems management.
Ability to communicate effectively both orally and in writing.
Ability to manage multiple priorities, functions independently, and demonstrate good follow through.
Ability to work positively and productively as a member of a team of colleagues, supervisors, agency staff and collateral contacts.
Ability and willingness to give and receive constructive feedback.
Ability and desire for personal and professional growth and skill development.
Must be culturally sensitive and competent in working in a multi-cultural environment.
Must demonstrate capacity for developing autonomy and leadership among employees.
Must demonstrate skills in working tactfully with others.
Flexible in assumption of responsibilities.
Must maintain ethical and professional standards.
Ability and willingness to work with all members of the community regardless of race, age, gender and cultural or ethnic background.
Ability to represent the agency in a professional manner.
Must have a valid State of Michigan driver’s license and automobile insurance.

Nice To Haves

Experience with credentialing/impaneling of providers/facility eligibility with payers highly preferred.

Responsibilities

Oversee and optimize the end-to-end revenue cycle, including charge entry, coding, claims submission, payment posting, and collections.
Develop, implement, and maintain revenue cycle policies and procedures
Manage daily operations of the revenue cycle department to meet financial and operational goals
Ensure accuracy and timeliness in account reconciliation, pre-collection, and post-collection processes
Investigate and resolve billing and authorization issues across public and private payers.
Maintain oversight of Service Activity Log processes to ensure regulatory compliance as well as state and federal guidelines.
Lead denial management efforts, including identification, analysis, and resolution of claim denials and rejections
Implement strategies to reduce A/R days, improve collections, and enhance profitability
Analyze payer contracts and reimbursement trends to optimize revenue
Recommend and implement process improvements to reduce errors and improve outcomes
Basic denial trend analysis and reporting
Ensure adherence to HIPAA, payer requirements, and federal/state regulations
Maintain up-to-date knowledge of payment reform and industry changes
Oversee internal and external audits, including quarterly coding audits, and implement corrective actions
Ensure provider documentation is completed accurately and within required timelines
Hands-on problem-solver in all aspects of collecting and billing including but not limited to working with funding partners.
Performs personnel functions such as hiring, training, terminating, and conducting employee evaluations and disciplinary actions, as necessary.
Ensure accuracy and integrity of patient billing information and internal records
Responsible for updating and correcting authorization errors that prevent services from being billed.
Monitors and maintains insurance contracts with all payers.
Ensures all providers are associated with each health plan contract and system is set up to accurately bill those health plans.
Stays abreast of payment reform changes and advises the administration team of these changes and provides recommendations for changes necessary.
Lead end-to-end provider credentialing and enrollment processes
Ensure timely credentialing/privileging, re-credentialing, and payer enrollment of behavioral health employees and clinic locations.
Enroll, update and re-attest as necessary for all health plan enrollment activity, keeping a detailed listing of all providers and their status with each contracted health plan.
Establish and maintain compliant credentialing policies and workflows
Serve as the primary contact for credentialing with health plans, auditors, and regulatory agencies
Cooperates in any investigation related to personnel, licensing, accreditation, or other circumstances.
Communicate in a professional manner with various Starfish Family Services team members, Detroit Wayne Integrated Health Network (DWIHN), health plans, and other entities.
Evaluate and initiate process improvement with clinical leadership to ensure efficient/effective day to day operations for responsible areas and stay current on any upcoming payer changes.
Provides reports and details to management team to carry out the necessary steps for a claim to be billable.
Training and educating management team on billing practices and revenue cycle processes.
Serves as the primary contact and expert for insurance companies as well as building and executing reports that accurately depict important business metrics and departmental metrics.
Actively seeks opportunities to improve financial outcomes, engaging revenue cycle team members in the process.
Responsible for following up on DWIHN risk matrix data. Provide summary and reports to senior leadership team.
Responsible for recommending changes to the senior director that would improve service delivery.
Support the CFO with financial reporting, audits, and cost reporting
Enhance workflow and revenue outcomes by analyzing (clinical) operational implementations, events, and potentially extended service lines of care that may result in heightened reimbursement.
Tracking and updating clinical reports and ensuring timely and routine updates are provided by clinical services team members.
Completion of reports from DWIHN to include but not limited disenrollment report and MCO report.
Participates in continued professional development including research and program presentation activities.
Attends local, county, state, and agency meetings and training courses as required.
Performs other duties as assigned by senior management.