Freeman

Compensation

Full Description

Revenue Cycle Manager Job Description Freeman Health Partners Medical Services, PC Position: Revenue Cycle Manager FLSA Status: Exempt EEOC Classification: First/Mid Level Managers and Officials Reports to: COO Job Purpose: The Revenue Cycle Manager is responsible for the strategic oversight and operational management of all revenue cycle functions within the organization. This includes patient registration, insurance verification, medical coding, claims submission, payment posting, denial management, accounts receivable, and collections. The manager will lead a team of billing and coding specialists, implement best practices, analyze financial data, and ensure compliance with all relevant healthcare regulations to optimize cash flow and financial performance. Primary Responsibilities: • Strategic Planning & Optimization: • Develop, implement, and refine revenue cycle policies and procedures to improve operational efficiency and maximize revenue. • Identify areas for process improvement and lead initiatives to enhance revenue integrity and reduce costs. • Collaborate with various departments (e.g., clinical, finance, IT) to streamline workflows and ensure seamless revenue cycle operations. • Stay updated on industry trends, payer policies, and healthcare regulations to adapt strategies accordingly. • Team Leadership & Management: • Lead, mentor, and develop a high-performing team of billing, coding, and collections specialists. • Set strategic goals for the team and ensure alignment with organizational objectives. • Conduct regular performance reviews, provide constructive feedback, and facilitate professional growth for team members. • Oversee daily operations, manage workloads, and ensure adherence to established procedures. • Claims & Denial Management: • Oversee the accurate and timely submission of claims to insurance companies and other payers. • Manage the denial and rejection management process, identifying root causes, implementing corrective actions, and ensuring timely resubmissions. • Negotiate with insurance providers and other payers to resolve complex billing issues and improve reimbursement rates. • Financial Analysis & Reporting: • Monitor key performance indicators (KPIs) related to revenue cycle performance (e.g., days in A/R, clean claim rate, denial rate, collection rates). • Analyze financial reports and data to identify trends, inefficiencies, and opportunities for improvement. • Present actionable insights and recommendations to leadership regarding revenue cycle performance and financial health. • Oversee monthly close processes, including reporting and account balancing. • Compliance & Regulatory Adherence: • Ensure all billing and collection processes comply with federal, state, and local healthcare regulations, including HIPAA, Medicare, Medicaid, and other payer requirements. • Conduct internal audits to ensure accuracy and compliance. • Develop and deliver training programs for staff on revenue cycle best practices, coding guidelines, and regulatory changes. • Patient & Payer Relations: • Oversee the resolution of patient billing inquiries and complaints, ensuring a positive patient financial experience. • Cultivate strong relationships with payers to facilitate efficient claims processing and dispute resolution. Education and experience, degree and/or certification required (if applicable): • Education: • Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Accounting, or a related field. • Experience: • Minimum of 5-7 years of progressive experience in healthcare revenue cycle management, with at least 2-3 years in a leadership or supervisory role. • Proven track record of optimizing revenue cycle processes and improving financial outcomes. • Technical Skills: • In-depth knowledge of healthcare billing, coding (ICD-10, CPT, HCPCS), and reimbursement methodologies. • Proficiency in revenue cycle management (RCM) software, electronic health record (EHR) systems, and practice management systems. • Strong analytical skills, including data analysis, financial modeling, and reporting (proficiency in Excel required). • Familiarity with medical necessity guidelines and compliance standards. • Soft Skills: • Excellent leadership, team management, and mentoring abilities. • Exceptional communication (written and verbal), interpersonal, and negotiation skills. • Strong problem-solving and critical thinking skills with a proactive approach. • Detail-oriented with strong organizational and time-management abilities. • Ability to adapt to a fast-paced, dynamic environment and manage multiple priorities effectively. • High degree of integrity and commitment to ethical conduct. • Preferred Qualifications: • Master’s degree in a related field. • Relevant certifications (e.g., Certified Revenue Cycle Representative (CRCR), Certified • Professional Coder (CPC), Certified Professional Biller (CPB)). Working Relationships: As a representative of Freeman Health Partners Medical Services, PC, all comments, actions and behaviors have a direct effect on Freeman Health Partners Medical Services, PC and its image and perception of quality care for the individuals we serve. Interactions with patient(s), staff, referral sources, guests and visitors, volunteer(s), and supervisors must be in a manner that is friendly, supportive, courteous, respectful and professional. This behavior should promote an atmosphere of teamwork that is congruent with Freeman Health Partners Medical Services, PC policies and procedures and set a standard and guideline to promote positive relations.