Revenue Cycle Manager

Report to: Chief Financial Officer

Status: Exempt

Core Values of Beloved Community Family Wellness Center:

Our core values include Compassion, Respect, Integrity, and Innovation. These values guide us in making day to day moral decisions and resolving ethical dilemmas, and defining the character of the Beloved Community Family Wellness Center.

Position Summary:

The Revenue Cycle Manager (RCM) is responsible for managing the revenue cycle process for all Beloved Community Family Wellness Center’s sites (BCFWC). This position is responsible for ensuring all providers are properly and timely credentialed within the State of Illinois IMPACT systems, and with all Managed Care Organizations that we contract with. This position is responsible for working with the Chief Operating Officer by ensuring accurate patient registration/documentation. This position ensures timely billing of all encounters, proper coding, claims processing/submission by BCFWC billers and by our outsourced billing company (Practice Management) PM, payment collection by BCFWC’s registration staff/billers and PM. The RCM ensures denial management activities are process in a timely manner by BCFWC’s billing staff and PM, and that we are in compliance with all relevant regulations; all while maximizing revenue, minimizing bad debt, and keeping the unique needs of BCFWC’s patient population in mind. This position includes training and supervision of billing staff; oversight of all billing related processes, monthly reporting of aged account receivables and maintenance of the schedule of charges. The position will report to the Chief Financial Officer (CFO), while working closely with all levels of management and provider staff.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Develop, implement and oversee effective billing and collections procedures.
• Train and supervise appropriate billing staff/organization employee to assist with the revenue cycle functions.
• Work with Chief Operating Officer, Office Managers, Clinical Managers, and providers to ensure all encounters are closed within 72 hours of service date
• Work with the Electronic Medical Records (EMR) Manager to ensure the appropriate configuration of all electronic billing systems are properly functioning for effective and efficient billing and collection processes.
• Work with the CFO to develop, implement and maintain fee schedules for all of our service areas in compliance with the Federal Poverty Guidelines for each of our service areas.
• Responsible for being in compliance with regulations: Must stay updated on and adhering to all federal and state regulations regarding billing practices, including HIPAA and Medicare guidelines.
• Generate regular reports on key revenue cycle metrics. For example: number of non-billable encounters for billable providers, outstanding encounters (past 72 hours of service date), collection rates, denial rates, and aged accounts receivable (61days to 180 or more days) to identify areas for improvement.
• Develop, implement and oversee procedures to ensure accurate coding; along with providing appropriate training for providers and staff.
• Monthly, ensure timely closing of the billing function.
• Prepare, review, report on and distribute end of month management reports (outstanding encounters, billable/non-billable encounters, coding errors, account receivable aging report, provider productivity).
• Provide support and training to practitioners to ensure accurate and timely filing of claims.
• Overseeing the accurate coding of all medical services provided to our patients, following proper FQHC billing guidelines. Ensure BCFWC’s billing staff capture charges and coding appropriately. Ensure the timely submission of all claims to Practice Management (PM) for processing of payment to Managed Care Organizations (MCOs) and third-party payers.
• Ensure PM personnel submit accurate and timely claims to payers, monitoring claim status, and addressing any issues with claim denials.
• Develop, implement and oversee procedures for the review, appeal and resubmission of all claim denials. Ensuring timely posting of patient payments and reconciling accounts receivable to minimize outstanding balances.
• Monthly, provide written explanation of all aged account receivable (91 to 180 or days) to CFO and CEO.
• Manage the reconciliation of all discrepancies found in billing records in a timely manner, and provide monthly reports to the organization’s management or outside entities (PM), as appropriate.
• Develop, implement and oversee procedures for the posting of all third-party payments received and the reconciliation of identified differences.
• Analyze claims data and suggest/implement procedures to maximize HEDIS and incentive revenue collections (i.e., all coding, ICD-10 and CPT modifiers, etc.).
• Provide oversight and management of billing staff work assignments.
• Conduct quality assurance and accuracy audits of patient accounts.
• Compile requested statistical, financial, billing or auditing reports.
• Provide personnel development at staff and practitioner meetings.
• Responsible for working with CFO to ensure timely refund of account overpayments.
• Coordinate and manage the organization’s Managed Care Organization’s MCOs rosters ensuring all patients receive scheduled appointments and gaps in services are addressed.
• Educating front-office staff, clinical staff, and billing team on proper revenue cycle procedures and best practices.
• Ensure billing staff verify insurance coverage for all patients and provide financial assessment (Sliding Fee Scale) on all self-pay/indigent patients status in a timely manner.
• Monitoring the FQHC's financial health related to revenue cycle activities, including identifying potential revenue leakage and implementing strategies to improve cash flow.

General Responsibilities:

• Work with the Chief Operating Officer to ensure that all Manage Care Organizations and Traditional Medicaid patients’ rosters are reviewed and that gaps in-services are addressed in a timely manner. Work with CINQCARE team to ensure patients who are assigned to BCFWC (but have not received care) are contact for care and/or removed from our roster.
• Assist CFO with preparation of Medicare and Medicaid cost reports.
• Handle routine correspondence and other administrative tasks, as required.
• Must be able to work productively and effectively in a complex environment, handling multiple and changing priorities. Deal with situations that appear stressful in a calm, positive and professional manner.
• Actively demonstrates a willingness to make a meaningful contribution to the work environment, as evidenced through behavior and attitude.
• Refrains from issuing unprofessional, offensive, inappropriate emails, text messages or other forms of written communication.
• Actively supports and participates in the organization’s performance improvement program.
• Demonstrates the ability to work in a multidisciplinary healthcare team environment.
• Participates in activities promoting professional growth and development.
• Participates in the mission, vision and values of the Health Center

Required Qualifications:

• Demonstrated knowledge of medical coding
• Bachelor’s degree; prefer Master’s or higher; or three years of relevant experience
• At least three years of experience in EHR/PMS environment
• Proficiency in Microsoft Office – Excel, Word, Outlook
• FQHC billing/coding/revenue cycle experience
• Three years (or more) of supervisory experience

Preferred Qualifications:

• Current medical coding or billing certification

WORK ENVIRONMENT:

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

PHYSICAL REQUIREMENTS:

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. This position requires frequent sitting, occasional bending, stooping, lifting and standing. It also requires frequent repetitive arm and finger movements on a computer keyboard.

Job Type: Full-time

Pay: $55,000.00 - $65,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $55,000 - $65,000