Revenue Cycle Manager

Benefits include:

Overview:

The Revenue Cycle Manager (RCM) serves as the agency expert in billing issues and works with executive staff to optimize financial performance through all phases of the medical billing process. The manager is responsible for managing staff, ensuring client eligibility, coding, billing, and collections. The manager works to reduce denied claims and ensure that the denied claim ratio is within industry standards or better, ensures compliance with Medicaid/Medicare and private insurance billing practices, and uses EHR data to maximize revenue for services provided. Along with the billing supervisor, the manager organizes and monitors the training and work of medical billing specialists and oversees the daily functions/tasks of the billing team assigned. Requires working knowledge of payer credentialing requirements, organization contracts, CPT, ICD and HCPCS coding in relation to mental health services as well as the State of Oregon’s Prioritized List with respect to which mental health services are covered under the Oregon Health Plan. Evaluates the billing processes and procedures and assists management in developing revisions.

Schedule: Monday-Friday 8am-5pm- onsite position

Responsibilities:

The RCM is accountable for ensuring all key performance indicators for the billing department are met including lower days in accounts receivable to improve cash flow, reducing the amount of claim denials, monitoring clean claim rate, and ensuring accuracy of claims entered by staff.

Oversees electronic health record billing processes and billing system integrity.

Performs audits of the billing system regularly to catch issues early and fosters a culture of compliance.

Looks for indicators such as duplicate billing, overlapping times, billing for unnecessary services, ensures credentials match the service being provided, etc. Identifies these issues and works with compliance on a plan to deny, re-coop, or pull back billing.

Ensures accounts receivable (AR) days are within industry standards.

Ensures denials are reviewed, appealed and reprocessed timely to ensure revenue is collected.

Develops and runs utilization review oversight reports for the agency and its contractors looking for irregularities in the system that may lead to fraud, waste and abuse claims. Identifies issues and reports them to executive leadership.

Works with Coordinated Care Organizations and other payers collaboratively to ensure billing is accurate and in alignment with contractual requirements.

Stays up to date on billing changes and ensures our systems align with the current laws.

Ensures agency is following latest billing regulations to stay in compliance with the Center for Medicare and Medicaid Services, Oregon Health Plan, private insurance contracts, …etc.

Ensures billing policies for different insurance companies are followed and billing rules are accurate within the system for each payer.

Works with internal EHR administrator, Chief Operations Officer, and Compliance Director to ensure the medical billing system meets the regulatory compliance guidelines and the agency’s system is set up to bill and report accurately. Reports issues early and works to find a resolution.

Qualifications:

High school diploma or GED.

Minimum 10- years of experience performing medical billing and accounts receivable, and a working knowledge of medical coding, terminology and billing practices required.

Requires knowledge of the State of Oregon’s Prioritized List including which mental health services are covered under the Oregon Health plan and the payment structure.

Requires a strong working knowledge of how the agency’s medical information system processes data in regard to the medical billing rules maintained in the EHR system.

Experience supervising department staff preferred.

Must pass state-required background and DMV checks. Candidate must be able to work independently and flexibly, under general supervision.

Possess business experience sufficient to meet the demands of the position, including proficiency with a variety of software applications.

Candidates must be able to use e-mail, compose documents, save and locate documents electronically, and learn to use our Electronic Health Record (EHR) system. Proficiency in Word and other MS Office applications preferred.

Options for Southern Oregon provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.