Revenue Cycle Manager

Pediatric Associates Family of Companies; Oregon; Hybrid; USD 90,000 - 120,000; Full time

Job summary

Pediatric Associates Family of Companies is seeking a Revenue Cycle Management leader to plan, organize, and manage front-office activities and lead policy development for RCM. You will drive cash collections, reduce days in accounts receivable, and ensure compliance with HIPAA and corporate guidelines.

The role includes supervising the RCM team, developing billing strategies for capitated and Medicaid FFS, coordinating with payers, and reporting metrics to leadership.

Qualifications

• Experience in supervisory or management in a medical environment preferred.
• Knowledge of billing and collection policies and procedures across all types of insurance (HMO, PPO, POS, Medicaid, etc.).
• Capitated agreements and Medicaid FFS expertise required.

Responsibilities

• Develops internal billing and collection policies to meet financial goals.
• Ensure cash collections and manage days in accounts receivable.
• Oversee productivity audits and monthly data reporting.
• Hire, train, and supervise management staff to meet department goals.
• Coordinate with payers to optimize reimbursements and handle appeals as needed.
• Maintain HIPAA compliance and confidentiality.
• Foster effective communication with front office and management.
• Represent the company to professional organizations and community.

Skills

Billing policy knowledge

Capitated agreements

Data interpretation

Communication skills

Education

High school diploma or equivalent

Tools

Microsoft Office

E-Medsys

Zirmed

Payer Websites

Job description

PRIMARY FUNCTION

This position is responsible for planning, organizing, and managing the activities of, as well as providing leadership, to the front offices. Develops, recommends, and administers company policies and procedures related to all revenue cycle functions. Responsible for ensuring cash collections, days in accounts receivables, adherence to corporate compliance and adjustments are within established goals set for the department.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all the duties that may be assigned

• Develops internal billing and collection policies and procedures to meet financial goals and objectives of the RCM department.
• Takes corrective action to ensure the company’s favorable position regarding changes created by the third-party payers.
• Assist with identifying and resolving outstanding patient accounts as related to capitated agreements and Medicaid FFS
• Oversees team’s productivity audits, track problematic trends, and compiles statistical data monthly.
• Interviews and selects subordinate management staff necessary to meet department goals and objectives
• Identifies services, charges, and billing methodologies that detract from the maximization of revenue reimbursement and takes steps to correct and/or communicate to the Director of RCM
• Follow up with insurance companies to ensure payment, evaluate reimbursements and make appeals when appropriate.
• Manages and is responsible for the overall satisfactory level of cash collections and days outstanding in patient receivables
• Evaluates the performance of subordinate personnel in a timely and effective manner.
• Research and reconcile Unapplied/Misapplied payments and credit balances
• Provides reimbursement, billing, and patient disposition guidance.
• Maintain strict confidentiality in accordance with HIPPA regulations and Company policy
• Develops and maintains appropriate communication and relationships with front office personnel and management in an efficient and effective manner
• Hold monthly staff meetings to maintain open communication with the staff and create a work environment to foster teamwork
• Represents the company to professional organizations and the community as necessary

QUALIFICATIONS

EDUCATION

High school diploma or equivalent.

EXPERIENCE

Three years of supervisory or management in a medical environment preferred.

LICENSURE / CERTIFICATION

Upon hire, and for the duration of the employment period, a driver’s license must be active and valid

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of billing and collection policies and procedures, all types of insurance (HMO, PPO, POS, Medicaid etc.)
• Must be an expert in capitated agreement and Medicaid FFS.
• Skill in defining problems, collection of data, interpreting billing information.
• Ability to communicate effectively and clearly.
• Applications utilized are Microsoft Office, E-Medsys, Zirmed, and Payer Websites.

TYPICAL WORKING CONDITIONS

• Non-patient facing
• May be either full time remote/telework or rotate working in the office and remote/telework
• This job must be U.S. based.
• Working in a professional office environment.
• The position involves high & frequent call volumes.
• Environment requires ability to multi-task, communicate clearly & concise, data entry for extended period of times.
• Will require sitting for long periods of time.

OTHER PHYSICAL REQUIREMENTS

• Vision
• Sense of sound
• Sense of touch