Revenue Cycle Manager in at Southeast Medical Group

The Revenue Cycle Manager is a pivotal role within the Revenue Cycle Management team, focusing on maximizing reimbursement through accurate coding practices and maintaining an up-to-date and quality patient clinical database. The individual in this position is responsible for overseeing claims analysis, contractual audits, monitoring billing practices, and implementing educational and financial recovery interventions. The role requires coordination with business office leadership to ensure compliance with current payer requirements and a commitment to outstanding customer service.

Key Responsibilities

Revenue Cycle Operations and Daily Billing Needs

• Manage and optimize the end-to-end revenue cycle process, including claims submission, payment posting, denial management, and collections to ensure timely and accurate reimbursement .
• Oversee daily billing operations, ensuring claims are processed efficiently and discrepancies in payments or denials are reconciled promptly .
• Monitor trends in claims data to identify areas of financial leakage and implement recovery strategies to maximize revenue .

Management of Hourly Staff

• Supervise and manage all hourly RCM staff, including scheduling, task delegation, and performance evaluations to ensure operational efficiency .
• Foster a culture of continuous improvement by providing training, mentorship, and career development opportunities for team members .
• Set performance standards for hourly staff, ensuring accountability and alignment with organizational goals .

Oversight of RCM Systems and Platforms

• Manage and maintain all RCM systems and platforms, ensuring data integrity, system functionality, and seamless integration with electronic medical records (EMR) and billing software .
• Troubleshoot system-related issues and coordinate with IT or vendors to resolve disruptions in billing or claims processing workflows .
• Stay updated on software upgrades or changes in healthcare technology to ensure systems meet current payer and regulatory requirements .

Audits and Compliance

• Conduct regular audits of billing and coding practices to ensure compliance with contractual agreements, payer requirements, and federal, state, and local regulations .
• Collaborate with the compliance department to address any identified issues and implement corrective actions during audits .
• Maintain the integrity and quality of the patient clinical database to support accurate billing and reporting .

Staffing and Resource Allocation

• Assess and manage staffing needs for the RCM department, ensuring adequate coverage for daily operations and peak periods .
• Coordinate with Human Resources to recruit, onboard, and train new hourly staff to meet operational demands .
• Recommend and facilitate educational interventions for staff to improve accuracy in coding and billing practices .

Collaboration and Customer Service

• Partner with other departments, including finance and business office leadership, to streamline revenue cycle processes and resolve operational inefficiencies .
• Actively participate in providing outstanding customer service, maintaining respectful relationships with patients, staff, and third-party representatives .
• Communicate effectively with team members and stakeholders to ensure alignment on RCM goals and payer requirements .

Qualifications

Education and Certification

• Bachelor’s degree in Healthcare Administration, Finance, or a related field required; Master’s degree preferred .
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification is highly desirable .

Experience

• Minimum of 3-5 years of experience in healthcare revenue cycle management, with at least 1-2 years in a supervisory or managerial role .
• Demonstrated experience in managing billing systems, conducting audits, and overseeing claims analysis .
• Familiarity with daily billing needs, staffing coordination, and operational workflows in a healthcare setting .

Skills and Abilities

• Strong leadership skills with the ability to manage and motivate hourly staff in a dynamic environment .
• Proficiency in RCM systems, EMR, and billing software, with the ability to troubleshoot and optimize platform performance .
• Excellent analytical and organizational skills to oversee audits, monitor financial trends, and manage daily operations .
• Knowledge of healthcare regulations, including HIPAA, CMS standards, and payer-specific requirements .
• Superior communication skills to collaborate with cross-functional teams and provide exceptional customer service .

Key Physical and Mental Requirements

• Ability to lift up to 50 pounds, push or pull heavy objects using up to 50 pounds of force, and sit or stand for extended periods .
• Ability to use fine motor skills to operate office equipment and/or machinery .
• Ability to receive and comprehend instructions verbally and/or in writing, and use logical reasoning for simple and complex problem-solving .
• Ability to travel to multiple locations to support business needs as required .

FLSA Classification: Exempt

Southeast Primary Care Partners is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

12/2024