RCM Manager at Paradigm Oral Health – Lincoln, Nebraska

Oversee and manage the RCM teams supporting the assigned Region. Lead, coach, and develop RCM supervisors and team members across all RCM functions and practice support models. Responsible for at least the following functions: insurance verification, billing, statement generation, insurance follow-up, collections placement, cash posting, office escalations and patient inquiries, and others. Review and “spot check” claims, statements, and other staff activities to evaluate if work product is produced efficiently and effectively, documenting any trends that need improvements. Ensure compliance with federal and state billing regulations; CMS, commercial payer, and dental payer requirements; as well as No Surprises Act, prompt-pay rules, and payer notification standardsProvide support to all team members as needed for arising situations (i.e field questions, practice relations, employee interactions, etc)Continuously evaluate RCM processes to identify inefficiencies or areas for improvement. Propose and implement strategies to streamline workflows and improve the net collection rate, reduce days in AR, and lower the percentage of AR over 90 days.  Schedule, plan, and run team meetings to discuss accounts, goals, and improvements. Provides education and training for new and existing staff membersCompletes corrective action meetings including verbal or written warnings with assistance from Human ResourcesRCM Ticketing and Teams Communication: Review speed and effectiveness of resolution of practice needs, account questions, and communication back to practice and/or patient. Ensure response time follows SLA and appropriately addresses initial ask. Audit team performance weekly and ensure that all RCM activities are processed in a timely, accurate, and compliant manner according to SOP and KPIs per role, holding team members accountable to target metrics.  Collaborate with other departments, such as finance, operations, credentialing, and clinical teams, to drive alignment and coordination across the revenue cycle continuum. Set clear performance expectations, accountability structures, and career development pathways for team members. Foster a culture of collaboration and communication to support organizational objectives.Provide feedback to RCM Director and VP to support quarterly and annual performance reviews for all team members. RCM Ticketing: Review speed and effectiveness of resolution of practice needs, account questions, and communication back to practice and/or patient. Ensure response time follows SLA and appropriately addresses initial ask.  Partner with Compliance and Legal teams on audits, payer reviews, and corrective action plans.Ensure teams are appropriately staffed in relation to volume-based staffing model per regional practice, and role alignment per team member is positively impacting RCM metrics. Review trends MoM to assist in setting departmental goals related to RCM metrics and provide input into strategic initiatives aimed at improving financial performance.  Report any compliance concerns to RCM Director or VP, and assist with resolution of compliance issues or discrepancies, working closely with the compliance department as needed.  Act as point of escalation for site leadership when account or patient questions arise. Coordinate research with appropriate role-specific team member and review outcomes with site leadership and/or direct manager.  Develop and maintain strong relationships with the practice operations team, practice administrators, and surgeons from support practices. Understand their businesses and preferred methods of central RCM support to provide an effective and functional services relationship. Other duties and responsibilities as assigned by leadershipKey RCM metrics:

Days in A/R – total and by payer typeA/R Aging – 90 and 120+Clean Claims RateRejection RateFirst-pass payment rateNet Collection RateCredit balance resolutionCost-to-collect

Prior experience in Dental Office workflows, Revenue Cycle functions to include Scheduling, Registration, Insurance verification, fee schedules, claim submission, charging/coding requirements, insurance AR follow up and payment posting processMust be knowledgeable of reimbursement/compliance process and procedures with all payorsExperience with practice management software systems, insurance portals, clearing houses, insurance guidelines, banking reconciliation software, proficient in intermediate PC skills (MS Office—strong excel skills). Strong computer literacy, Excellent Math and problem-solving skills. Data entry and 10-key by touch.Strong interpersonal and organization skills. Ability to work within a team setting and as an individual contributor. Excellent oral and written communication skillsResponsible for quality work, meeting deadlines, and adherence to Compliance and Revenue cycle standard operating proceduresOrganized work habits, accuracy, and proven attention to detail with strong analytical skills