Summary: The Revenue Cycle Manager—Front End provides leadership for the department and its members while actively participating in all department activities including such tasks as insurance verification, visit authorizations, rejection and denial research processes. This position co-ordinates the daily work of the staff. It is responsible for team performance, education and training and may help with clinic front office training. It is responsible for documenting current processes, analyzing work flow along with tracking and monitoring departmental KPIs and metrics. This position ensures the quality of training materials, policies, and procedures for the team. It collaborates with and reports to the Vice President of Revenue Cycle. The ability to collaborate with and support internal and external customers is essential.

Essential Duties and Responsibilities:

• Demonstrate knowledge of and ability to accurately verify insurance eligibility and benefits
• Demonstrate an ability to research and interpret payer medical policies and guidelines
• Follow appropriate internal and external processes to identify when authorizations/referrals are required and obtain when needed
• Work and communicate with clinic team to provide timely update on authorization
• Provide follow-up on outstanding authorization issues
• Follow appropriate internal standards, policies and procedures to maximize reimbursement
• Handles phone calls from patients and clinical teams regarding prior-authorizations for services ordered/scheduled
• Serves as back-up for team members who are out of the office
• Responsible for researching and resolving payer rejections and denials related to eligibility and prior authorization providing reporting and root cause analysis
• Day to day coordination of team. This includes work allocation, training, and problem resolution.
• Experienced in using Microsoft office products including word, excel, power point and Microsoft Teams
• Responsible for managing employee performance including annual evaluations, coaching and mentoring and the corrective action process as applicable
• Responsible for leading team huddles and staff meetings
• Monitors processes and workflows for compliance with established policies. Provides individual or team training as needed.
• Monitors staff productivity and KPIs
• Offer input regarding new policies and objectives consistent with those of the organization to promote efficient operation.
• Offer input regarding key performance indicators and is responsible for tracking, reporting and any associated process improvement activities

This list of duties is not intended to be all-inclusive and may be expanded to include other duties or responsibilities that senior management may deem necessary.

Supervisory Responsibilities

• Interviews, hires, and trains new staff in the department.
• Oversees the daily workflow of the department.
• Provides constructive and timely performance evaluations.

Qualifications/Skills

• High School Diploma required with post high-school education in the areas of management and/or healthcare preferred.
• 2 or more years of recent, relevant experience with patient insurance benefit verification and/or obtainment of prior authorizations for treatment as required by specific payers is required.
• 2 or more years supervisory/leadership experience preferred.
• Experience with physical therapy preferred.
• Proven ability to handle multiple responsibilities simultaneously in a complex environment.
• Excellent time management skills with a proven ability to meet deadlines.
• Strong analytical and problem-solving skills.
• Strong supervisory and leadership skills.
• Demonstrated communication skills, both written and verbal, to effectively interface and maintain effective relationships with all levels internally and externally.
• The ability to use Microsoft Office and other software programs as necessary to prepare appropriate analysis and reports.
• Use of sensitive information in a confidential and discretionary manner.

Performance Measurements:

• Supervisory and leadership skills
• Organization
• Communication
• Follow-through of responsibilities

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear. The employee is frequently required to sit at a desk for prolonged periods of time while working on a computer. They are also required to frequently reach with their hands and arms.

Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.