Senior Revenue Cycle Manager in Middlebury, Connecticut at Waterbury Hospital

Summary

In this role, you will be responsible for ensuring that goals and objectives of the RCM team are properly defined and clearly established.

Key Roles & Responsibilities

• Manage a staff of up to 20 Reimbursement and Coding Specialists holding them accountable to productivity and accuracy benchmarks
• Ensure that department activities are managed pursuant to the Polices & Procedures Manual
• Report and explain benchmarking metrics for all functional areas of department
• Compile, analyze, and prepare various status reports for senior management review to identify trends and make recommendations
• Maintain up-to-date expertise and knowledge of Physician Ambulatory billing and related laws and regulations
• Ensure claim denials are being reviewed and analyzed to determine if automated rules can reduce certain denials
• Provide provider coding audits on an as needed basis
• Provide coding education and training to providers on an as needed basis
• Responsible for coordination of all external coding and documentation audit activities with outside consultants and third party payers including Federal and State agencies (i.e., RAC, CERT, PCA, MAC, ZPIC etc.).
• Reviews and studies all information published by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative to coding, billing and reimbursement compliance.
• Reviews and studies all information from third party payers relative to claims filing, coding, and the adjudication process
• Proven ability to provide feedback and training to physicians and company leadership regarding federal and state coding regulations, medical documentation, and compliance guidelines; audit results; and risk areas.
• Strong familiarity with medical terminology and the patient medical record required. Knowledge of multiple EMR systems required (Allscripts PRO, Allscripts Touchworks, Athena a plus)
• Works with Director of Revenue Cycle Management to establish baseline benchmarks for department functions and department staff member productivity
• Handles escalation of complex patient and/or Physician requests and/or complaints
• Performs Annual employee reviews of direct reports
• Represent UH | CNMG's at business meetings with billing partners/vendors, clients, and other related organizations
• Assist Director of Revenue Cycle Management with the managing and maintenance of multiple RCM system applications. Includes adding/editing Providers, Insurance Carriers, CPT Codes, Diagnoses, Practice Locations, coding rules, and system upgrades
• Work closely with Director of Revenue Cycle Management and EMR department to ensure EMR templates are designed to maximize payor reimbursement
• Assist Director in managing multiple revenue cycle groups and multiple Practice Management Billing systems to include several New England locations.

Qualifications

• Education and Experience:
  • High School diploma or GED required
  • Associates Degree desirable
  • Certified Professional Coder (CPC) desirable
  • Minimum 10 years of experience preferred in Physician Healthcare billing. Practice Management experience a plus
  • Minimum 5 years of experience in a Management role required
• Personal Qualities
  • Innovative
  • Resourceful
  • Independent
  • Enthusiastic
• Computer skills
  • MS Office, especially Excel
  • Crystal Reports desirable
  • Business Intelligence application (Precision BI a plus)
  • Practice management applications (Allscripts Ntierprise and Athena a plus)
  • EMR applications (Allscripts PRO, Allscripts Touchworks, Athena a plus)
• Broad understanding of Medical billing and RCM operations.
• Proficient in CPT/ICD-10 Coding and Billing.
• Skillful in problem resolution.
• Encourages teamwork, energetic, and positively motivates teams and individuals.
• Excellent analytical and problem solving skills.
• Excellent oral and written communication skills.
• Excellent organizational and time management skills.
• Ability to work both independently and within a team.
• Ability to handle multiple assignments simultaneously.
• Ability to lead others toward objectives and goals.