Full-Time Revenue Cycle Manager​

 

Redwoods Rural Health Center is seeking a Revenue Cycle Manager who will be under the direct supervision of the Finance Director. The Revenue Cycle Manager ensures the effective billing systems to optimize revenue from diverse sources, including patient and insurance payments, payor accounts receivable, and cross-departmental billing relationships.

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ESSENTIAL FUNCTIONS:

SUPERVISORY RESPONSIBILITIES: 

• Trains, supervises, and manages the Billing department’s assignments

• Liase with organizational departments on billing matters and training

• Conducts performance evaluations that are timely and accurate

DUTIES AND RESPONSIBILITIES:

• Responsible for billing, payment posting, claims and denial management

• In cooperation with the CFO and Finance Director, develop, implement and oversee effective billing and collections procedures to ensure RRHC mEets compliance requirements

• Manage the configuration of all electronic billing systems to ensure proper functioning for effective and efficient billing and collection processes.

• Maintain fee schedule for each service area

• Responsible for managing the 3rd party billing and collection vendor to optimize cash collection

• Monitor and report on all open accounts receivable

• Manage the reconciliation of all discrepancies found in billing records in a timely manner, and provide reports to management or outside entities, as appropriate.

• Responds to billing inquiries from staff and practitioners, providing support and training to ensure accurate, timely filing of claims

• Ensures system-generated reports are accurate

• Ensure timely monthly close of the billing function, including preparing end of month management reports at the direction of the Finance Director.

• Assist with preparation of Medicare and Medicaid cost reports.

• Analyze claims data and suggest/implement procedures to maximize HEDIS and incentive revenue collections (i.e., level II HCPCS codes, ICD-10 and CPT modifiers).

• Complete analysis or reporting as required

• Provide guidance on escalated non-payment of bills to include, but not limited to, writing claims inquiries, correcting errors and re-submitting claims

• Performs coding audits as directed by the Finance Director to assure the appropriate submission of billing and diagnosis codes

• Coordinate and manage the practitioner insurance enrollment/credentialing process with all outside entities.

• Maintain and manage all applicable registrations and periodic reporting for CMS (Medicare and Medicaid).

• Review and recommend provider insurance plan network participation agreements.

• Participates in the mission, vision and values of the Health Center.

• All other duties as assigned

CORPORATE COMPLIANCE/SECURITY RESPONBILITIES: ​

•  Upholds all HIPAA requirements in a manner consistent with CCHC’s policies, professional standards of conduct, state and federal laws/regulations governing FQHC’s.

• Upholds security responsibilities for the protection of CCHC IT systems and data, including:

• adherence to user password guidelines.

• restraint from leaving workstation unsecured.

• appropriate use of Internet access while at work and while utilizing EJFHC devices.

• use of abundant caution regarding phishing emails; and

• prompt reporting of lost/stolen IT devices.

• Reports suspected violations of code of conduct, policies, procedures, laws and regulations to a supervisor, the compliance officer or to the anonymous compliance hotline.

QUALIFICATIONS

• Associate’s degree in business or other related discipline AND four (4) years of related experience

• Bachelor's degree in business or other related discipline AND two (2) years of related experience

• 1-2 years of supervisory experience required

• Healthcare experience AND/OR Billing/Medical Coding Certificate preferred

KNOWLEDGE, SKILLS, AND ABILITIES

• Proficient use of software applications i.e. Microsoft Office and billing software

• Demonstrated ability to respond effectively to requests for reports with detailed analysis

• Demonstrated ability to learn complex computer software applications

• Ability to take initiative and to exercise independent and sensible judgment

• Demonstrate decision-making and problem-solving expertise.

• Ability to collaborate and work effectively with the management team, community members and external agencies

• Working knowledge of ICD-10 and CPT coding structures

• Working knowledge Medicare, Medi-Cal and other public programs

• Demonstrated competency in understanding payor program policies and procedures

• Strong customer service orientation

• Ability to maintain confidential information.

INTERPERSONAL:

• Listens and communicates well with staff, leadership, providers, and patients

• Accepts constructive criticism well.  Provides constructive criticism in an appropriate manner

• Works well under pressure and maintains a positive and productive energy-level

• Shows professionalism and poise when dealing with patients, providers, and co-workers

• Demonstrates a sense of urgency and a commitment to providing excellent service. 

COMPETENCIES:

• To perform the job successfully, an individual should demonstrate the following competencies to perform the essential functions of this position. 

• Problem-solving—the individual identifies and resolves problems promptly and gathers and analyzes information skillfully

• Quality control—the individual demonstrates accuracy and thoroughness and monitors own work to ensure quality; and

• Adaptability-the individual adapts to changes in the work environment, manages competing demands, and can deal with frequent change, delays, or unexpected events​​

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For more information about the position
including benefits, please contact:

chswan@rrhc.org • 707-353-2147 or

submit a letter of interest & resume to
PO Box 769, Redway, CA 95560