Revenue Cycle Manager

PEDIATRIC EAR NOSE & THROAT OF ATLANTA PC; Georgia; On-site; USD 85,000 - 120,000; Full time

Job summary

PEDIATRIC EAR NOSE & THROAT OF ATLANTA PC is seeking a Revenue Cycle Manager to oversee the billing, coding, collections, and denial management across the practice. You will ensure accurate coding, timely submissions, and effective cash flow.

You will lead the revenue cycle team, coordinate with vendors, and implement policies to optimize reimbursement, while maintaining HIPAA compliance and strong internal controls.

Qualifications

• Bachelor’s degree and 3-5 years of related work experience.
• Knowledge of third-party payer requirements including federal, state, and private health care plans and authorization process.
• Proven experience in healthcare billing, including Medicaid.
• Knowledge of basic insurance policies, procedures, and reimbursement practices with Medicaid and commercial coding.
• Experience supervising staff.
• Experience with process development and execution.
• Excellent communication and interpersonal skills.
• Background screen including Social Security Verification, Education Verification, and Credit Check is required.
• Preferred: 3 years healthcare management experience.
• Preferred: Certified coder, coding auditor, or coding education experience.

Responsibilities

• Oversee and manage entire revenue cycle including billing, coding, collections, and denial management.
• Manage relationships with external vendors for practice management software and clearinghouse vendor.
• Communicate professionally with various payers.
• Manage, develop, and mentor all revenue department staff, including billers and coders and RCM/Admissions Supervisor.
• Team with the operations team to oversee the registration process and manage the registration process team.
• Responsible for management and maintenance of billing and practice management software platform.
• Provide up to date education for clinical, billing, and coding staff on coding trends.
• Develops, evaluates, implements, and revises policies and procedures related to billing, coding, reimbursement activities and improvement strategies.
• Reconcile all receivables and revenue reports and work closely with the finance department in the development of the monthly financial statements.
• Manage and update the charge master based on the current CMS fee schedule and negotiated contracts.
• Conduct monthly analysis of Medicaid/Third Party Payers.
• Oversees the processing of credentialing and provider enrollment applications, initial, and re-enrollment status with all Medicaid, Medicare, and Commercial Payors.
• Responsible for the generation and management of revenue, registration and credentialing metric reports.
• Review and resolve issues related to claim generation and rejected/denied billings.
• Commit to highest level of business and patient confidentiality possible adhering to all HIPAA and security guidelines when accessing and sharing patient information.
• Technical expert for practice management system (eg. Mod Med).
• Keeps abreast of all reimbursement billing procedures of third party and private insurance payers and government regulations.
• Maintains appropriate internal controls over accounts receivable, RCM process.
• Monitors accounts sent for collection and reimbursements from insurance companies and other third-party payers.
• Reviews, monitors, and evaluates third party reimbursement and researches variances.
• Participates in the development of coding and billing strategies, evaluating process relative to revenue cycle, and making recommendation

Skills

Communication skills

Interpersonal skills

Leadership

Attention to detail

Education

Bachelor’s degree

3-5 years healthcare experience

Certified coder or coding auditor (preferred)

Tools

Mod Med

Job description

Job Description

Revenue Cycle Manager

Department: Revenue

Position Summary: The Revenue Cycle Manager is responsible for overseeing revenue cycle management including coding, billing, collections, and denial management as well as financial reporting within the organization. This position is responsible for ensuring claims, denials, and appeals are efficiently processed, and resolving billing-related issues. The Revenue Cycle Manager will minimize bad debt, improve cash flow, and effectively manage accounts receivables. This role will also manage Provider credentialing. The Revenue Cycle Manager will be the main contact for the Practice Management vendor, Medicaid contacts, clinically integrated networks and Clearing House vendor. They will be responsible for setting the annual practice fee schedule. This position is to stay apprised of coding and revenue trends; and is responsible for coding education to clinical and coding/billing staff. In addition, this position will manage all Revenue Cycle Management staff including billers, coders, team assistants, and the RCM supervisor; this will include day to day supervision as well as development opportunities, training, and mentorship.

Supervision Received: Director of Finance/Partners at Pediatric Ear Nose and Throat of Atlanta
Supervision Exercised: Coders, Billers, Team Assistant, and RCM Supervisor

Classification: Full-Time

Required Education and Qualifications:

• A bachelor’s degree and 3-5 years of related work experience
• Knowledge of third-party payer requirements including federal, state, and private health care plans and authorization process
• Proven experience in healthcare billing, including Medicaid.
• Knowledge of basic insurance policies, procedures, and reimbursement practices with Medicaid and commercial coding
• Experience supervising staff
• Prior experience with process development and execution
• Excellent communication and interpersonal skills
• This is a financially sensitive position and is contingent upon clear results of a thorough background screen including: Social Security Verification, Education Verification, and Credit Check

Preferred Education and Qualifications:

• 3 years healthcare experience at the management level
• Certified coder, coding auditor, or coding education experience

Essential Functions:

1. Oversee and manage entire revenue cycle including billing, coding, collections, and denial management

1. Manage relationships with external vendors for practice management software and clearinghouse vendor
2. Communicate professionally with various payers
3. Manage, develop, and mentor all revenue department staff, including billers and coders and RCM/Admissions Supervisor
4. Teams with the operations team to oversee the registration process and manage the registration process team
5. Responsible for management and maintenance of billing and practice management software platform
6. Provide up to date education for clinical, billing, and coding staff on coding trends
7. Develops, evaluates, implements, and revises policies and procedures related to billing, coding, reimbursement activities and improvement strategies
8. Reconcile all receivables and revenue reports and work closely with the finance department in the development of the monthly financial statements
9. Manage and update the charge master based on the current CMS fee schedule and negotiated contracts
10. Conduct monthly analysis of Medicaid/Third Party Payers
11. Oversees the processing of credentialing and provider enrollment applications, initial, and re-enrollment status with all Medicaid, Medicare, and Commercial Payors
12. Responsible for the generation and management of revenue, registration and credentialing metric reports
13. Review and resolve issues related to claim generation and rejected/denied billings
14. Commit to highest level of business and patient confidentiality possible adhering to all HIPAA and security guidelines when accessing and sharing patient information
15. Technical expert for practice management system (eg. Mod Med)
16. Keeps abreast of all reimbursement billing procedures of third party and private insurance payers and government regulations
17. Maintains appropriate internal controls over accounts receivable, RCM process
18. Monitors accounts sent for collection and reimbursements from insurance companies and other third-party payers
19. Reviews, monitors, and evaluates third party reimbursement and researches variances
20. Participates in the development of coding and billing strategies, evaluating process relative to revenue cycle, and making recommendation