What are the responsibilities and job description for the Revenue Cycle Manager position at Mental Health Services for Clark & Madison...?
Revenue Cycle Manager
FT, 40 Hours per week
The Revenue Cycle Manager oversees end-to-end revenue operations for the behavioral health organization spanning outpatient, inpatient psychiatry, school-based services, ACT/Community-Based programs, and telehealth. This role ensures accurate patient access and financial clearance, compliant charge capture and coding, high first-pass claim yield, timely cash posting, proactive denial prevention, and strong payer relationships—driving sustainable net revenue while upholding HIPAA and 42 CFR Part 2 requirements
Responsibilities
- Own the full revenue cycle (pre-service, mid-cycle, back-end) and lead a high-performing team with clear goals, SOPs, and QA audits.
- Partner with Clinical, Utilization Review, IT/EHR, and Compliance to align workflows, reduce friction, and support organizational growth.
- Lead month-end close tasks for revenue, including accruals, variance analysis, and write-off oversight.
- Oversee insurance verifications, benefits coordination, prior authorization management (including concurrent reviews for inpatient psych), and financial counseling and ensure timely, complete documentation to support medical necessity and authorization requirements.
- Ensure accurate, timely charge entry for behavioral health CPT/HCPCS (e.g., therapy, psychiatry, IOP/PHP where applicable), revenue codes, POS (including 02/10 for telehealth), and required modifiers.
- Coordinate provider education and documentation audits to prevent under/over-coding; partner on clinical workflow fixes Manage clean claim production for 837P/837I, rejection work queues, secondary/tertiary billing, and timely filing standards.
- Oversee 835 auto-posting, unapplied cash, credit balance resolution, refunds, and reconciliation to the general ledger.
- Establish root-cause tracking for denials (eligibility, authorization, coding, medical necessity, COB, late filing) with closed-loop prevention.
- Lead effective appeal strategies and regular payer meetings; maintain payer portal and clearinghouse operations and 835/remark-code mapping.
- Maintain compliance with HIPAA, 42 CFR Part 2, state Medicaid and Medicare rules, managed care contract terms, and No Surprises Act (as applicable).
- Support internal/external audits and implement corrective action plans.
- Build and maintain KPI dashboards (e.g., clean claim rate, first-pass yield, days in A/R, % A/R > 90, denial rate, auth turnaround, DNFB, charge entry lag, cash-to-net).
- Partner with IT/Analytics to optimize the EHR and clearinghouse edits; steward master data (payers, fee schedules, service locations, NPI/Taxonomy).
- Contribute to RCM requirements for EHR upgrades or migrations (e.g., charge router, work queues, 835 mapping
- Follows all universal precautions for safety, infection control and follows all state, federal and joint commission health and safety standards.
- Treats patients and family with dignity and respect and holds all patient information in the strictest confidence.
- Adhere to professional standards, policies and procedures, federal, state and local requirements and Joint Commission standards, including National Patient Safety Goals. Presents a positive image of MHSCC to other community agencies, caregivers and citizens
- Completes all MHS required education and training, including initial agency orientation, mandatory training and education, and upkeep of all required certifications and licensures as required by state, federal and regulatory requirements.
- Demonstrates organizational stewardship and exemplifies the mission, vision and values of MHS.
- Performs other job-related tasks as assigned
Education/Experience
- Bachelor’s degree in accounting, business, health administration or related field preferred
- 2 year’s supervisory experience in a healthcare setting (preferred)
- Experience with EHR, commercial and private insurance billing and regulations
- Experience with Joint Commission, federal and state (Ohio) regulations and standards (preferred)
Licensure/Certifications
- CPB, CRCR, CPC or CCS preferred
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