The Revenue Cycle Manager is responsible for the implementation, execution, and completion of all day-to-day Revenue Cycle functions, while ensuring workflows remain aligned with strategy, commitments, and goals of PPMW. The Revenue Cycle Manager will lead or direct the work of Reimbursement Specialists and Insurance Benefit Verification specialists to improve billing processes, minimize denials, and ensure timely and correct posting and follow up. The Revenue Cycle Manager will collaborate with health center managers and staff on trends, denials, and areas needing training and retraining. The Revenue Cycle Manager will perform all billing and collection functions in order to meet affiliate goals and deadlines. The Revenue Cycle Manager will play a key role in managing any projects alongside the routine workflows of PPMW.

• Lead, direct and coordinate daily ERA, EOB, and patient payment posting and billing. Ensure month-end reconciliation processes are completed on time and accurately.
• Analyzation of self-pay balances, trends, and identification of training needs
• Ensure PPMW's KPIs are satisfied. Monitor and report on progress, challenges, and solutions to internal stakeholders.
• Conduct follow-up with team members and provider reps to track action items and affiliate progress.
• Implement and manage workflow change.
• Ensure month-end activities are completed in a timely manner and that month-end reconciliation is accurately completed.
• Coordinate, participate in, and manage communications (calls, updates) as needed with internal and external stakeholders (e.g. affiliate staff, payer groups.
• Run appropriate Epic reporting to track and monitor payer-specific claim adjudication trends.
• Provide detailed weekly/monthly/quarterly reporting, as needed, for management review.
• Submit daily electronic and paper claim files, and correct all claim and charge review edits, warnings and errors; run statement files; and download ERAs/EOBs as needed.
• Perform daily ERA, EOB, and patient payment posting.
• Maintain relationships with contracted payers, and other contracted entities to ensure maximum reimbursement.
• Audit work of reimbursement specialists and insurance benefit verification specialists; arrange for any needed retraining or provide areas for improvement, as applicable.
• Oversee and improve billing and collection strategies and systems.
• Perform payment posting functions, participate in billing line call center, and claim follow-up as needed.
• Run all reports needed to manage the claims business for assigned affiliates.
• Participate in Revenue Cycle team meetings/conference calls, and provide the necessary reporting, feedback, and training required to improve processes.
• Complete special projects as needed.
• Other responsibilities as assigned.

· Bachelor's Degree or equivalent experience required.

· At least five years' experience in medical billing and Accounts Receivable management.

· Epic Credentialed Training Certification in Professional Billing and Claims

· Preferred credentials – Certified Professional Coder

· Experience with patient billing and demonstrable understanding of the nuances of grants or entitlement programs

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Reasoning Ability

Must have the ability to define problems, collect data, establish facts, and draw valid conclusion. Ability to multi-task and to work effectively under pressure due to conflicting demands is required. Must be flexible, highly organized, creative, and detail-oriented with the ability to set and meet deadlines.

Language Skills

Ability to read, analyze and interpret productivity reports industry periodicals government regulations and legal documents along with the ability to effectively present information to staff at all lev ls of the affiliate and the board of directors. Must have the ability to write reports, business correspondences, and procedure manuals. Requires excellent verbal and written communication skills, including listening and interpersonal relationship communication skills as well as coaching and collaboration. This must include strong presentation and public speaking skills with the ability to interact with a diverse group of staff and internal and external customers appropriately and professionally, including PPMW's Board of Directors.

Mathematical Skills

Must possess the ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Requires ability to interpret basic financial data and communicate implications to managers. Must have the ability to develop and manage a budget, including elements of cost analysis, cost management and revenue forecasting.

Computer Skills

Excellent keyboarding skills with high level of accuracy required. Must have demonstrated proficiency with Microsoft Office, possess capacity to learn software programs required for specific position and must be able to access electronic communications, including e-mail, Extranet, Intranet, and Internet.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The employee must possess a demonstrated ability to work in a diverse environment and build productive relationships. A demonstrated ability to effectively work independently and collaboratively as part of a team is essential.

· Noise levels in the work environment is usually moderate.

· Protestors may be present at work and related sites.

· The position may require frequent travel to multiple sites. Employee must provide own reliable transportation and possess a valid driver's license for the performance of agency duties.

Travel

Job requires less than 5% travel to headquarters in Washington DC.

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. All the job functions listed within this job description involve to greater and lesser degrees the following physical demands: close vision; hearing/listening; clear speech; walking; lifting and carrying up to 25 pounds; stooping; kneeling; bending; sitting; standing; and use of digits of hands to handle, feel and use keyboard.

Compensation details: 76000-121000 Yearly Salary

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