Description

The Healthcare Financial Management Association (HFMA) defines revenue cycle as "All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue." ln other words, it is a term that includes the entire life of a patient account from creation to payment. Revenue cycle processes flow into and affect one another. When processes are executed correctly, the cycle performs predictably. However, problems early in the cycle can have significant ripple effects. The further an error travels through the revenue cycle, the more costly revenue recovery becomes.

Responsible for the improvement of utilization and other operational activities that support the overall objectives of MHHS. Will strive to continuously streamline operations, improve daily system usage and functionality.

The RCM will be responsible for overseeing the billing teams and all billing operation processes (i.e,

insurance eligibility processes, charge processing, claim submission/processing, payment processing,

collections and A/R, denial management, reporting results and analysis, concurrent and retrospective

auditing, proper coding, and insurance contract reviews). Oversee the day to day activities of the central

business office.

Health care revenue cycle management involves many strategies, including procedures that hospitals

and clinics use to improve cash collections and meet liquidity goals. These strategies also include

customer receivables valuation, underpayment recovery policies and transactions involving federal

government programs such as Medicare and Medicaid.

Oversee departments associated with revenue cycles, including billing, collections, health information management, etc. Work closely with CFO in monitoring, educating, management of staff. Review payors contracts, payments and reimbursement. Ongoing monitoring, Management of claims processing, payments and revenues. Utilizing technology as an essential tool for monitoring and educating staff, providers, patients and public.

compliance with CMS, Medicare, Medicaid, payors, etc. Sliding Fee and charity care programs.

Qualifications

1. Experience in A/R management, EOB interpretation, working with payers to correct issues with claims

adjudication, line item payment posting, electronic claim submission, clearinghouse set-up, and

intermediate knowledge of Excel with ability to utilize for data analysis. Understanding of basic Business Office functions to include patient registration and checkout, billing process via electronic and paper claim method, EOB interpretation and payment posting, denial tracking and denial resolution process,

all aspects of accounts receivable management.

1. Experience in hospital, Rural Health clinic, Federally qualified Health center, Dental, Long Term care,

Ambulance, etc. and/or business office leadership preferred.

1. Experience in successfully managing of a team. Project Management experience required
2. Willingness to learn and educate yourself.
3. Bachelor's Degree in business or related field is preferred. Health care administration/revenue cycle

management experience preferred.

1. The individual in this position must take ownership in their leadership position, be dependable and

desire the opportunity to lead a team environment.

1. Must have excellent attention to detail and the ability to prioritize work flow and projects to meet

deadlines and demonstrate the ability to think critically under pressure.

1. Requires computer and systems competency in the following areas: working knowledge of systems and

interfaces preferably with CPSI, NextGen, Therapy Source, and LTC software, Microsoft Word, Microsoft

Excel and Microsoft Outlook.

1. Excellent writing and verbal communication skills and professional positive attitude are required.
2. Must have knowledge of revenue cycle management process local/state/federal regulations, Fair Debt

and Collection Practice Act, medical terminology, claims adjudication process and payer contract

familiarity.

1. GAAP? Working closely with CFO
2. Solid understanding of information systems
3. Must be detail oriented, organized, and have strong multi-tasking abilities
4. Competency in HIPAA Security regulations
5. Ability to demonstrate supportive relationships with peers, vendors, partners, and corporate/facility

executives

1. Strong knowledge of medical insurance billing and collections, coding and medical terminology, as well

as an overall understanding of Medicare and other third party payers

1. comprehensive knowledge of claims management, HIPAA standards, CMS requirements, managed

care, CPT, ICD-9, 10 and HCPCS Coding

1. Knowledge in healthcare compliance, including privacy and security regulations, confidentiality laws,

access and release information

1. Excellent and innovative problem solving skills and analytical abilities
2. strong sense of urgency and ability to meet required deadlines
3. Requires an understanding of multiple systems and processes that impact revenue cycle performance

and capabilities.

1. Possesses analytical ability sufficient to work in a data-heavy environment and to identify trends in the

data.

1. Effective communication (i.e., listening, written and verbal), negotiation, influencing decision makers,

business planning, strategy, problem solving, decision making and time management skills.

1. Understanding of the market, trends, competition, and key pain points for hospital executives.
2. Must be able to work in sitting position, use computer and answer telephone

Ability to travel between sites includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments