Revenue Manager

Indian Health Board of Minneapolis • Minneapolis, MN

5d

About The Position

This position will ensure IHB's financial needs are met by maximizing the revenue cycle, maintaining cash flow, and safeguarding assets. This requires an understanding of the administrative, strategic, and clinical implications of all aspects of the revenue cycle. This individual will have hands-on experience and in-depth knowledge of health information management systems as well as medical, dental, recovery services, and mental health coding and documentation standards, claims submission requirements, and EDI management.

Requirements

• BA/BS in healthcare or related field, plus at least 5 years of claims billing experience with a health care provider or certification from NHA as a billing and coding specialist plus at least 8 years of billing experience with a health care provider.
• 2+ years of direct professional staff supervisory experience.
• Intermediate to advanced skill level with Microsoft Office applications, especially Excel, Access, and Medical EDI software, preferably Epic or Ochin.
• Manages time effectively and prioritizes completing tasks to meet deadlines.
• Strong knowledge of federal and state regulations related to the position.
• Strong analytical and problem-solving skills.
• Excellent written and oral communication skills.
• Able to work independently and as part of the management team.
• A wide degree of creativity and latitude is necessary.
• Ability to process and maintain information in a confidential manner.
• Strong communication, organizational and leadership skills are a must.

Nice To Haves

• Experience working with FQHC's preferred.

Responsibilities

• Responsible for compliant and accurate claims processing and management: including provider set-up, claims entry, through EDI, resolution and resubmission of errored claims, and correct payment and adjustment entry. IHB benchmark is that 99% of claims are processed.
• Manage and implement changes pursuant to changes or updates to CMS, DHS, or other payer reimbursement rules and guidelines.
• Manage and support timely claim submissions and follow up, including efforts to assure billing benchmarks.
• Maintain dental upfront payment schedule for Sliding Fee Scale fees. Work with dental department on processes and procedures to provide treatment plan cost estimates and capturing payments upfront
• Update fee schedule annually, develop new fees as required, monitor and update flat fees, in conjunction with Finance Director.
• Maintain and update Medical Lab orders.
• Ensure effective use of EDI system to streamline electronic claim release and payment receipt from payers.
• Provide reports to leadership and staff monthly, or as needed, on billing metrics including analysis of adjustments, payment and collection rates, denial reasons and payer mix. Offer measurable objectives to improve metrics.
• Maintain optimal set-up in Ochin (Epic) EHR and Practice Management for billing and payment including managing fee schedules, provider set-up, transaction column sets, Medicare G codes, order sets, provider custom lists, sliding fee scale, procedure codes including fees, and other billing tables.
• Work with management and other staff to ensure effective processes for obtaining provider credentialing, visit pre-authorizations, restricted patient access compliance, complete registration forms and insurance verification.
• Work with Department Directors to complete annual coding compliance audits.
• Administer websites or other tools for insurance verification and patient eligibility.
• Optimize patient self-pay and point of service collection processes.
• Ensure the accuracy of cash collection and application to accounts.
• Responsible for cost reporting submissions to Medicare and Medicaid, ensuring most advantageous rate for Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) calculated by the Minnesota Department of Human Services. Responsible for Quarterly CMS Credit Balance reporting.
• Assist in preparation and submission of grant requests and reporting including the UDS
• Research and implement processes and procedures for ancillary clinic revenue generating services, including Health Care Home.
• Resolution of technical issues relating to the insurance claim processes and updating processes as needed.
• Responsible for billing department customer service and communication with internal and external parties, including patients and third-party vendors/insurance companies, and including being in the billing phone queue as necessary.
• Analyze, evaluate, and improve billing department procedures and processes.
• Update Billing policies as required.
• Assist in planning, coordinating, and completing information requests for annual financial audit, third party payers and grant authorities.
• Other duties as necessary.
• Supervise 2-5 staff members.
• Hiring staff through interviewing process.
• Training and retraining staff including creating and using job aids and training tools as needed.
• Implementation of IHB wide and department level policies and procedures.
• Coaching staff in their ability to perform job functions.
• Regular productivity tracking and annual performance evaluations.
• Disciplinary actions as necessary.
• Manage and approve time off requests and timecards.
• Establish and maintain successful relationships with various funding entities, outside auditors and department heads.
• Monitor, and report, the registration and medical record activities of the Medical, Dental, and Counseling & Support departments to ensure appropriate data is collected to ensure all third-party payor sources are identified for billing, charges are properly captured, and statistical and other information is gathered for regulatory reporting.
• Stay current on regulatory and third-party payor requirements.
• Other job-related duties assigned by Supervisor.

Benefits

• Platinum benefits package available for employees working 30 hours per week or more: Health, Dental, Vision, FSA
• Company paid long term and life insurance
• Generous paid time-off
• Retirement savings plan with employer match

What This Job Offers

• Job Type: Full-time
• Career Level: Manager