Overview
This role involves managing and overseeing the Revenue Cycle Management functions, including Billing, Technical Claim Denials, and Appeals. The position requires effective supervision, process improvement, compliance adherence, and coordination with internal teams and external vendors to ensure accurate and timely billing and collections.
Responsibilities
Billing
- Oversee and streamline billing and collections processes.
- Facilitate accurate and timely billing and resolution of issues by collaborating with internal and external stakeholders.
- Manage the collection of receivables.
- Design, develop, and continuously improve billing processes.
- Identify and implement process and system improvements to drive automation.
Denial Management
- Analyze, interpret, and identify insurance denials and related performance variations.
- Develop and execute denial prevention plans based on core analytics to identify root causes.
- Review and categorize monthly denial and write-off trends to inform improvement goals.
- Collaborate with revenue cycle stakeholders to focus denial prevention and management efforts.
- Identify and escalate payer-specific issues.
- Disseminate information regarding government and third-party payor regulations to relevant departments.
- Monitor performance metrics against best practice targets and influence denial reporting tool development.
Leadership
- Provide effective supervision including setting clear performance expectations, coaching, and resolving performance issues.
- Communicate transparently and address difficult issues openly.
- Demonstrate inclusive leadership and foster active collaboration.
- Set clear direction and expectations.
- Measure and document team performance.
Additional Duties
- Perform other related duties as assigned.
Qualifications
Education and Experience
- High school diploma or equivalent required.
- Bachelor’s degree in healthcare administration, business, or related field.
- Minimum of 3 years billing and accounts receivable management experience in a medical facility, ambulatory surgery center, or acute-care hospital.
Preferred Qualifications
- 2 years of supervisory or managerial experience.
- Master’s degree preferred.
Skills and Abilities
- Advanced proficiency in MS Office and Excel.
- Clear understanding of Federal, State, and NCQA time frames and contractual legal requirements.
- Knowledge of CPT, HCPCS, ICD-10, and medical terminology preferred.
- Ability to identify trends in denials and appeals and report results to internal committees and regulatory bodies.
- Thorough knowledge of patient financial services processes related to billing, collections, and cash posting.
- General knowledge of patient registration, finance, and data processing.
- Strong analytical and problem-solving skills.
- Excellent written and verbal communication skills.
- Strong customer service orientation and attention to detail.
Physical Demands
- Regularly required to sit, stand, walk, reach with hands and arms, talk, and hear.
- Occasionally required to climb, balance, stoop, kneel, or crouch.
- Occasionally lift, push, and/or move up to 30 pounds.
- Vision requirements include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
Work Environment
- This is a remote position with possible travel to practice locations in other states.
- The noise level is typical of an office setting.
Position Details
- Position Type: Full Time
- Work Place Type: On-site
- Category: Corporate Support