Revenue Cycle Manager

PT Solutions Physical Therapy

6d•$75,000 - $85,000

About The Position

The Revenue Cycle Manager is responsible for managing and supervising the central billing and collection operations for Private Clinic AR and Payment Posting to ensure accurate and timely submission of claims, prompt collections, aggressive denial management payment posting, and credits. They will support the A/R and Payment Posting Supervisor in process and workflow improvements and implement payor billing changes as needed. The Revenue Cycle Manager is responsible for leading special projects and escalating and corresponding elevated issues with payers to resolve reimbursement issues efficiently and effectively. Will provide effective and timely communication of department issues or success to Director and VP. Ensures compliance with relevant laws, regulations, established company policies and compliance programs. Employee will share the vision and mission of PT Solutions. Regularly reviews the workflows and processes of the Revenue Cycle team to identify opportunities for efficiency and workflow improvements Develops, monitors and assesses team metrics in order to refine processes and improve processes to ensure team members are hitting the expected metrics. Works collaboratively with Supervisors and specialists to provide monthly trainings and refreshers based on recent payor changes, recent claims processing and recent reviews of process improvement. Monitors new clinics in the first 90 days in relation to charge posting, payment posting, claims billing, denials and items that can affect revenue for new locations. Performs regular internal audits of the aging AR to maximize the collection of payments and reimbursements from insurance carriers, and coordinates with the Revenue Cycle Supervisors to address any inefficiencies in staff performance. Responsible for coordinating and escalating special projects with payers in relation to reimbursement issues to ensure claims processing is accurate and full reimbursement is obtained. Meets regularly with clinical and front office leadership team to provide feedback on trends relating to denials and write-offs caused by clinic practices, to initiate retraining or any needed corrective action. Works collaboratively with third party Revenue Cycle vendors for additions, improvements, builds of new clinics and any other applicable needs. Collaborates with internal and external auditors by gathering documentation, providing billing records, and ensuring compliance with regulatory and payer requirements. Supports the organization's adherence to Single Case Agreement (SCA) requirements by maintaining accurate wage determinations, reviewing billing practices for compliance, and assisting with required reporting and documentation. Coordinates with medical records staff to ensure timely access to documentation necessary for billing, audits, and payer requests; ensures records meet compliance and billing requirements. Leads and manages the Remote Therapeutic Monitoring (RTM) billing process, ensuring accurate coding, timely claim submissions, and compliance with payer guidelines and regulatory standards. Makes use of management practices that include empowerment of staff, the provision of clear and concise expectations regarding duties assigned to employees, frequent feedback focusing on both positive and problematic aspects of work performance and other management practices that are consistent with Continuous Quality Improvement. Promotes and maintains harmonious and effective relationships and communications within the department and with other departments. Provides leadership support and oversight of RCM team.

Requirements

Excellent supervisory skills including coaching, performance improvement and training.
Detailed knowledge of Medicare, Medicaid, commercial insurance billing and other payers along with associated billing/collections timelines.
Strong analytical and problem solving skills with the ability to move issues forward to resolution.
Ability to understand complex reimbursement contracts.
Ability to relay information clearly and communicate effectively.
Bachelor’s degree in Health Care or Business, or equivalent OR 4 years of revenue cycle management experience required
At least four (2) years of medical revenue cycle management experience required with a consistent track record of achieving metrics.
Overall revenue cycle experience should exceed nine (5) years.
Individual must have strong knowledge of medical insurance billing and collections with CPT, ICD9, and HCPC coding and medical terminology, as well as an overall understanding of managed care products (HMO, PPO, etc.)
Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint)

Responsibilities

managing and supervising the central billing and collection operations for Private Clinic AR and Payment Posting
support the A/R and Payment Posting Supervisor in process and workflow improvements and implement payor billing changes as needed
leading special projects and escalating and corresponding elevated issues with payers to resolve reimbursement issues efficiently and effectively
provide effective and timely communication of department issues or success to Director and VP
Ensures compliance with relevant laws, regulations, established company policies and compliance programs
Regularly reviews the workflows and processes of the Revenue Cycle team to identify opportunities for efficiency and workflow improvements
Develops, monitors and assesses team metrics in order to refine processes and improve processes to ensure team members are hitting the expected metrics
Works collaboratively with Supervisors and specialists to provide monthly trainings and refreshers based on recent payor changes, recent claims processing and recent reviews of process improvement
Monitors new clinics in the first 90 days in relation to charge posting, payment posting, claims billing, denials and items that can affect revenue for new locations
Performs regular internal audits of the aging AR to maximize the collection of payments and reimbursements from insurance carriers, and coordinates with the Revenue Cycle Supervisors to address any inefficiencies in staff performance
Responsible for coordinating and escalating special projects with payers in relation to reimbursement issues to ensure claims processing is accurate and full reimbursement is obtained
Meets regularly with clinical and front office leadership team to provide feedback on trends relating to denials and write-offs caused by clinic practices, to initiate retraining or any needed corrective action
Works collaboratively with third party Revenue Cycle vendors for additions, improvements, builds of new clinics and any other applicable needs
Collaborates with internal and external auditors by gathering documentation, providing billing records, and ensuring compliance with regulatory and payer requirements
Supports the organization's adherence to Single Case Agreement (SCA) requirements by maintaining accurate wage determinations, reviewing billing practices for compliance, and assisting with required reporting and documentation
Coordinates with medical records staff to ensure timely access to documentation necessary for billing, audits, and payer requests; ensures records meet compliance and billing requirements
Leads and manages the Remote Therapeutic Monitoring (RTM) billing process, ensuring accurate coding, timely claim submissions, and compliance with payer guidelines and regulatory standards
Makes use of management practices that include empowerment of staff, the provision of clear and concise expectations regarding duties assigned to employees, frequent feedback focusing on both positive and problematic aspects of work performance and other management practices that are consistent with Continuous Quality Improvement
Promotes and maintains harmonious and effective relationships and communications within the department and with other departments
Provides leadership support and oversight of RCM team