Revenue Cycle Manager (RCM)

This individual is responsible for managing the policies, objectives and initiatives of the revenue cycle activities to achieve revenue targets and to optimize the patient financial interaction along the care continuum. This includes accountability for patient eligibility, referrals and authorizations, daily reconciliation, resolution of billing inquiries and patient/caregiver education on the billing process, management of patient billing inquiries. This position requires full time, on-site availability.

Responsibilities

Coordinates with Area Managers regarding information required during patient registration, patient insurance, billing/collections, and data processing to ensure accurate patient billing and efficient account collection.
Manages practice/department within the established budget, including annual planning, and develops monthly status reports.
Reviews status of patient accounts to identify and resolve billing and processing problems in a timely manner.
Routinely travel between all locations to educate clinical staff regarding various RCM processes, and to interact with all MD’s and company leadership.
Establishes and implements a system for the collection of delinquent accounts, ensuring third-party payers are contacted.
Establishes and recommends credit and collection policies. Makes recommendations for improvement.
Audits problem accounts and takes appropriate action to achieve amicable outcome between patient and the practice.
May meet with new patients and caregivers in assigned department(s) to orient them to billing processes and expectations.
Develops and implements new procedures to improve the quality and quantity of work processed. Ensure policies are communicated and administered consistently. Develops and oversees business systems and works with Information Technology to ensure timely and accurate implementation.
Initiates and answers pertinent correspondence. Prepares operational and financial reports and analysis, noting progress as well as adverse trends. Makes appropriate recommendations or conclusions. Maintains required records and files.
Oversees insurance authorization department to ensure patient insurances are eligible, necessary referrals and/or authorizations are obtained and entered appropriately into the PM system prior to patient appointments and claims are paid appropriately.
Monitors daily operating activities of assigned department and makes suggestions necessary for improved workflow and efficiency.
Maintains knowledge of and complies with established policies and procedures including government, insurance, and third-party payer regulations.
Works collaboratively with physician and physician staff to ensure proper coding compliance.
Liaison to insurance carrier representatives; creates and monitors special claims project appeals.
Direct liaison to pharmaceutical representative during drug reimbursement; claim reimbursement processes; prior authorization requirements, etc.
Conducts and/or leads quarterly chart audits to maintain compliance.
Works collaboratively with the COO and RCA team on Payor contract issues/negotiations.
Works in conjunction with COO, and Accounting Manager to report and/or review all billing measures/KPIs.
Monitors all billing staff claims productivity, quality, and quantity, for staff working in office or remotely, including thirdparty RCM staff.
Act as primary interface with third-party RCM vendor to ensure success. Attending weekly meetings, monitoring KPI’s, etc..
Performs staff annual performance reviews and sets appropriate goals and expectations.
Monitors staff PTO and approves timecards.
Will onboard new physicians and/or locations into the Practice Management system, and work directly with the credentialing team.
Conducts special projects and studies, as directed.

Benefits

• Medical Insurance Plans
• Vision Insurance Plan
• Dental Insurance Plan
• 401K Contribution
• Life Insurance
• Sick, Vacation, and Holiday Pay
• Certification Opportunities

• Bachelors degree in finance, business administration, healthcare administration, or a related field;
• Or equivalent education and experience;
• 7-10 years’ experience in RCM
• Proven experience in healthcare billing
• Must have 5 years of billing staff management experience.

Preferred Skills:

• Strong working knowledge of revenue cycle business office operations and supervision.
• Exceptional communication, listening, coaching, facilitation and conflict resolution skills.
• Strong computer skills including experience using all Microsoft Office applications..
• Attention to detail and the ability to prioritize tasks independently.
• Strong critical thinking and problem solving skills.
• Must be able to establish and maintain effective working relationships with patients, medical staff, management, and peers.
• Ability to work in a team and independently

Who We Are

California Retina Consultants (CRC) is part ofRetina Consultants of America (RCA), the largest network of leading retina specialists with the mission of saving sight and improving patient lives through innovation and the highest quality care. Through RCA's physician-centered practice management model, physicians continue to drive clinical and practice culture while benefiting from the available business expertise, resources and shared best practices.

Equal Opportunity Employer

California Retina Consultants is proud to be an Equal Employment Opportunity and an Affirmative Action Employer. We are committed to creating an inclusive work environment that celebrates diversity.

All offers are contingent upon satisfactory background check and pre-employment drug screen.