Description

Responsibilities

1. Manages the staff of the revenue cycle function:

• Determines the most effective method for assigning responsibilities and duties to department employees.
• Assigns duties and responsibilities, and ensures employees receive instruction/training needed to complete their job responsibilities.
• Reviews departmental work for thoroughness and accuracy; provides specific instructions to employees on completion of tasks/responsibilities.
• Ensures that employees are aware of and adhere to all company policies and procedures and conveys all senior leadership communications and directives.
• Makes recommendations for functional/departmental budget; maintains and monitors approved budgets.
• Maintains job descriptions, procedures and other documentation related to the organization of the department.
• Prepares and conducts performance appraisals for immediate staff, including establishment and implementation of professional developmental plans;
• Provides recommendations on hiring, corrective actions, and terminations; executes coaching.
• Responsible for timeliness of charge activity and account follow-up. Develops innovative methods for increasing staff productivity, quality and effectiveness of revenue cycle management.
• Assists as primary liaison and resource to programs, providers, payers, and other departments on all issues related to revenue cycle management.

2. Manages the coding, billing, and collection functions:

• Reviews and approves write offs and refund requests.
• Ensures that all set-ups in the practice management system are correct for third party payers to meet Federally Qualified Health Center (FQHC) reporting requirements (such as Uniform Data System (UDS), Medicare, and Medicaid cost reports).
• Ensures that OI billing and coding practices are in compliance with federal and state law and regulations.
• Ensures the Third Party Billing team is effectively managing Work Queues.
• Conducts provider training on proper ICD 10 and CPT coding
• Subject matter expert on Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-10) coding to providers and billing staff.
• Maintains a collaborative relationship with third-party payers and identifies problems contributing to timely payments and denials.
• Assists operations staff and clinic managers in implementing billing and coding procedures, as necessary.
• Coordinates with Fiscal Director in managing the fee schedules as needed.
• Provides back-up for billing staff as needed to ensure deadlines are met.
• Builds and maintains relationships with third party payers in order to ensure reimbursement according to contracts and recommends and assists with contract negotiation.

3. Develops, sets up, and monitors electronic claim submission:

• Analyzes and reports on revenue cycle management such as: Identifying and minimizing preventable denials and write-offs, monitory systems workflow evaluating trends for the total business and for individual programs and providers. Generates all routine reports. Develops and generates appropriate forms.
• Works to create claims process efficiencies.
• Collaborates with Third Party Billing team to ensure timely resolution of claims issues, denials management root cause analysis, and successful payment posting.
• Conducts billing audits as needed.
• Maintains a current Revenue Cycle Procedures Manual:
• Develops and updates revenue cycle policies and procedures consistent with Federal, State, and local laws and regulations.
• Ensures that billing and collection policies and procedures are reviewed annually and created and updated as appropriate.
• Develops and implements daily billing and coding techniques and operations.

Creates, maintains, and reviews revenue cycle reports:
4. Reviews metrics with Third Party Billing team to maintain key performance indicators.

• Develop and share best practices with direct and cross functional team members. Research and maintain compliance of billing industry standards
• Manages EHR system functions in support of revenue cycle management including analysis, modification of data tables, maintains and submits required support tickets
• Reviews dashboards to trend accounts receivable, denials, charge lag, and performance in risk capture and quality metrics.
• Develops and utilizes appropriate quality improvement tools to measure accuracy and efficiency of billing; identifies areas of concerns and reports to the Chief Financial Officer (CFO).
• Assists CFO with ensuring all deadlines are met for key financial performance reports, special projects, and other assigned tasks.
• Assumes overall responsibility for billing and collecting payment for services due at time of service, as well as other patient balances and maintains awareness of billing policies and third party regulations.
• Prepares revenue entries for the accounting system by compiling and analyzing billing information.

Qualifications

General Professional Development:

• Self-Direction: Develops priorities for effective performance of duties, including re-prioritization in response to changes in circumstances.
• Analysis Skills: Analyzes data and presents results using both established tools/techniques and individually developed creative methods; draws both objective and subjective conclusions, using inference and logic, in presenting results.

Professional and Technical Knowledge:

• Possesses professional skills, including written and verbal communications skills, computational and computer skills, and mathematical knowledge at a level typically acquired through completion of a general bachelor’s degree program.
• In addition to advanced general knowledge, requires knowledge and expertise in a non-technical general profession (e.g., business administration, etc.), which may include some specific or technical training, but is generally acquired through experience.
• Possesses a deep knowledge of revenue cycle management with a minimum experience of 2 years

Experience with EHR and billing systems; experience with OCHIN Epic reporting tools strongly preferred

• Strong knowledge of contracts and reimbursement methods. Technology savvy with experience software and web applications related to billing functions.
• Commitment to recruiting, mentoring, training, and retaining a diverse team; the foresight and ability to delegate accordingly
• Strong communication skills, including presentation and education around complex topics; experience in effectively communicating key data.
• Demonstrated experience monitoring performance of revenue cycle management KPIs (key performance indicators)
• At least two years of staff supervision experience strongly preferred
• Federally Qualified Health Center (FQHC) experience strongly preferred.

Licensing and Certification:

• Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) certification strongly preferred.