RCM Manager

Francisco Partners; Raleigh (NC); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Veradigm is seeking a Manager to lead the RCM team responsible for all related medical billing activities, maximizing accounts receivable collections for clients. You will supervise productivity and performance to meet financial goals and ensure AR health, while providing oversight of processes and workloads.

The role involves coordinating with client representatives, ensuring accurate CPT/ICD coding, and guiding staff to resolve issues efficiently.

Qualifications

• Extensive knowledge with email, search engines, Internet.
• Ability to effectively use payer websites and LaserFiche.
• MS Office tools including Outlook, Word, Excel, PowerPoint.
• Knowledge of CPT, ICD10 and modifiers.
• Experience with billing systems such as Next Gen, Pro, Allscripts, Epic.

Responsibilities

• Manage staff productivity for follow-up of unpaid, denied, and underpaid/overpaid claims.
• Meet with client representatives to review billing progress and resolve issues.
• Ensure accurate entry of charges, CPT/ICD codes, and demographics in billing systems.
• Oversee staff who enter payments and understand EOBs, deductibles, and credits.
• Interact with clients and patients to resolve questions and improve satisfaction.
• Provide guidance to team and serve as primary point of contact for work matters.
• Deliver timely reports to RCM Management and escalate issues when needed.
• Track AR productivity and health daily/weekly/monthly.
• Stay current with AR policies and month-end deductions and denials.
• Review work by outside vendors and implement improvements.
• Aim to achieve management and compliance goals.
• Enforce adherence to company policies and processes.

Skills

Email

Search engines

Internet

Payer websites

Microsoft Office

CPT coding

ICD-10 coding

Modifiers

Communication

Tools

Next Gen

Pro

Allscripts

Epic

LaserFiche

Job description

Manages a RCM team who are responsible for all related medical billing activity for the purpose of maximizing accounts receivable collections for clients. In addition to performing similar work, the Manager will oversee and ensure group productivity and performance in accordance with financial goals to ensure the health of the client's Accounts Receivable Supports RCM Management by efficiently and effectively providing oversight and review of the team, processes and workload.

Responsibilities

• Responsible for staff productivity for follow-up of all unpaid, denied, and underpaid and overpaid claims. This includes but is not limited to: contacting insurance companies for claim status, reviewing all insurance claims and patient documentation, reviewing and ensuring appropriate coding, handling correspondence, and making appropriate decisions for follow-up action. Must be effective at handling several accounts simultaneously and ensuring maximum accounts receivables and expedient collection turnaround for clients.
• Meets with Client representatives to review billing progress, status of a accounts and review and resolve any issues presented by clients.
• Ensures that staff and/or vendor, as applicable enters all charges into the medical billing system accurately and correctly for reimbursement. This includes but is not limited to: ensuring correct CPT codes, modifiers, and ICD codes, authorizations for services, patient demographics, and health insurance data.
• Responsible for staff who enters all patient, insurance, and third party payments into the medical billing system. This includes a thorough knowledge and understanding of medical EOB’s, patient deductibles and co pays, and insurance or third party correspondence, contractual payments and adjustments.
• Interact with clients and their patients, engage in proactive resolution of issues and timely response to questions and concerns.
• Strong customer service skills for client satisfaction, health of client AR and management of RCM team members
  • answering client inquiries; prompt return and follow up to all interactions; prompt response to requests for information, both internally and externally
  • acts as primary point of contact for team members and provides guidance on work matters
• Deliver timely required reports to the RCM Management; initiates and communicates the resolution of issues
• Meet regularly with staff; in-person and as a group to confirm the status of client accounts and build/sustain staff engagement to drive business results and improvements
• Track clients’ AR productivity and health (charge, payments, collections, adjustments) on a daily, weekly and/or monthly basis; as needed to ensure the client and company expectations are met
• Remain current with company’s policies and procedures regarding AR activity such as, reviewing month end reports to insure the AR and cash collections are meeting agreed upon benchmarks, identifying trends, reviewing denial reports
• Analyze reports to determine when, how and why decrease in clients’ AR; includes denials, unbilled, credit issues, holds; determine corrective actions and communicate with client and staff to resolve. Follow up to ensure actions are taken that achieve the results needed and/or determine other resolution needed
• Review work performed by outside vendors for accuracy and production. Determine changes/improvement needed and works promptly and appropriate with applicable individuals to bring about such changes/improvement
• Achieve goals set forth by management and compliance requirements
• Follows, enforces and models adherence to all policies, procedures and processes

Knowledge, Skills and Abilities

• Extensive knowledge with email, search engines, Internet
• Ability to effectively use payer websites and LaserFiche
• Intermediate practical knowledge and use of Microsoft products; Outlook, Word, Excel, PowerPoint
• Preferred experience with MS Access, Crystal reports
• General knowledge of and the ability to learn/regularly use various billing systems, EMR’s and interfaces
• Previous experience with various billing systems, such as Next Gen, Pro, Allscripts, Epic and others
• Accounting skills preferred
• Knowledge of CPT, ICD10 and modifiers.
• Experience in specialties such as Psychiatry, Internal Medicine, Orthopedics, General Surgery
• Familiar with HMO and IPAs, Medicare Fee for Service Plans and Commercial Payers
• Strong communication skills

Working Arrangements

• Standard work week or as defined by assignment requirements
• Primarily works in standard office environment or remotely
• May require after-hours, on-call support and/or holidays
• On-call and after hours work during peak times including end of month/quarter/year; during this time PTO is limited to meet business needs

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.

Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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