Organization: Beloved Community Family Wellness Center Category: Manager Location: Chicago, IL Date Job Posted: October 21, 2020 Share with Others:
Revenue Cycle Manager-Temp to 3 months
The Revenue Cycle Manager provides oversight and guidance to the billing area, provider credentialing process, and clinical support functions associated with claims processing, payments, and patient revenue generation for the Beloved Community Family Wellness Center (BCFWC). This position supports the growth of the health center through collaboration across the clinical, administrative, and billing teams associated with providing healthcare services to BCFWC’s targeted patients and communities. This position reports to the Chief Financial Officer.
Coordinates all processes relating to physicians/providers credentialing, patient insurance verification, sliding fee scale processing, and pre-authorization and insurance re-determination to support an efficient and successful revenue cycle process.
Responsible for timely processing and maintaining physicians/providers credentialing information in the State of Illinois IMPACT system and with all the organization’s health insurance plans contracts as this information impacts the organization revenue cycle management.
Identifies insufficient credentialing documentation and work with physicians/providers to collect appropriate documents, edits, etc. to insurance plans, hospitals, and State of Illinois IMPACT system in order to resolve issues that may arise and to ensure timely processing of credentialing application.
Ensure physicians/providers do not have Medicaid, Medicare, or third party insurance companies’ sanctions against them. Monitors and communicates (immediately) outcomes of credentialing status (or change in status) to the Chief Executive Officer, Chief Medical Officer, and Chief Financial Officer upon notification.
Responsible for maintaining contact with insurance companies to insure they have all the necessary documents. Must inform insurance companies/State of Illinois IMPACT system when there is a change of status or any changes in contracts, policies and separation of physician/provider that would affect usual business with the health center.
Analyzes claims denials and identified solutions to increase cash and A/R days.
Works with the Billing Company, clearinghouse, and the payers to ensure all claims are processed and received by the insurance companies in a timely manner.
Overhauls billing policies and procedures to eliminate gaps and standardize processes.
Works closely with the billing team to review and efficiently manage office tasks relating to claims reimbursements, payment posting, statement processing, collections, claims denials, financial assessments (sliding fee scale) and patient insurance re-determination.
Collaborates with management and clinical teams in establishing and maintaining key performance indicators for the revenue cycle operations.
Works with the Chief Financial Officer (CFO) and outsourced Billing Company to utilize statistical reports, and other analytical tools to track claims through the entire lifecycle, ensuring payments are collected and determining the root cause of denied claims.
Utilizes technology and other tools to strategize with the billing team and Practice Administrator in identifying, developing, and implementing systems and process improvements to promote more efficient revenue cycle operations—appointment scheduling, patient registration and insurance verification, collections, encounter utilization review, charge capture and coding, claims submissions, third party follow-up, remittance processing and rejections.
Maintain quality levels, conduct random charge/coding audits, and works with health center team/personnel to resolve problems.
Develops, implements, and updates billing policies and procedures to ensure efficient operations to maximize BCFWC’s patient service revenue.
Annually working in conjunction with the CFO develop sliding fee scale in compliance with Federal Poverty Guidelines and health center’s sliding fee scale Policies and Procedures.
Supervises the billing team.
Improves non-financial staff understanding of billing activities information by providing education sessions health center-wide.
Conducts assessments of patient billing and revenue collection systems to design and implement revenue cycle improvements.
Analyzes and resolve problems that affect the claim submission process, regardless of whether the problem originates in the area under direct or indirect control.
Trains physicians/providers and lead in-service presentations to ensure compliance on correct coding and documentation.
Serves as enthusiastic resource to assist Practice Administrator, Patient Care Coordinators (PCCs) physicians/providers, executive and billing team in problem solving difficult patient accounts, information system issues; with the goal of efficient and timely resolutions that result in positive outcomes.
Provides clear communication, guidance, and leadership to teams in carrying out the sliding fee processing, claims processing, payments, and patient revenue generation supporting high quality service to patients.
Regularly provides CFO with revenue cycle status including reports and metrics.
Works with health center personnel across the board to foster a cohesive team-oriented work environment. Provides leadership and guidance across BCFWC’s clinics to ensure timely and efficient collection of patient revenue collections.
Supports staff in defining priorities, deadlines, and resolving any revenue cycle challenges.
Applies strong verbal and written communication skills to build and foster relationships with Chief Financial Officer, Chief Executive Officer, Chief Medical Officer, health center’s employees, external stakeholders, and vendor partners in support of maintaining a streamlined and efficient revenue cycle.
Develops, execute and maintains a detailed plan to improve the revenue cycle and continually reduce days in accounts receivable, increase cash collections, reduce bad debt write-offs, eliminate write-offs due to revenue cycle processes, improve insurance verification accuracy, sliding fee scale processing; along with improving customer service and increase patient satisfaction.
Assist in preparing UDS reports.
Develops and monitors performance measures for billing team for annual performance management review.
Responsible to retrieve all health plans monthly member’s roster to forward Practice Administrator, Site Manager and CFO by 5th business day of every month.
Compile and prepare various Billing and Revenue Cycle status reports for CFO, as requested and guide by CFO.
Perform Billing and Revenue Cycle related special projects and other duties as requested by CFO.
Assist with month end and year end close; and annual audit preparation and schedules.
Assist in the preparation and timely submission of UDS report, Medicare cost report and Medicaid cost report.
Perform other duties as to be assigned, changed or revised from time to time.
Education, Experience, Certifications
Eight or more years relevant experience in health center billing operations is essential
Strong knowledge of medical insurance billing and collections with CPT, ICD-10, and HCPC coding, medical terminology as well as overall understanding of managed care products (MCO’s, PPO, etc.)
Five or more years of progressive leadership
Ability to process and maintain confidential matters and information
Proficiency in Microsoft Office (Outlook, Excel, Word, Access, and PowerPoint)
Bachelor’s degree in Finance, Business, or equivalent.
Master’s Degree preferred or eight years of revenue cycle management experience required.