The Revenue Cycle Manager is a key component of the Clinical Operations team and will own critical activities as the company continues to experience significant growth. The ideal candidate will lead by example and be eager to dive in and execute tasks as they come up with strategies on how to best scale RCM activities. This is a fast-paced highly dynamic start-up environment, and this individual must be an effective leader and doer.

Duties and Responsibilities

• Accountable for development and execution of all Biofourmis RCM activities
• Management of direct day-to-day revenue cycle operations and teams across different time zones
• Will work closely with internal and external stakeholders to ensure all aspect of claims-based billing and collection processes are developed and launched
• Will develop a roadmap and strategies for scaling revenue cycle practices, including transition planning and analysis showing the benefits of moving from third party RCM vendors to in-house staff as the company scales
• Will develop business models that show the benefits and tradeoffs of making adjustments to key processes within the RCM workflow.
• Will manage third-party RCM vendors and grow an internal team to execute on Biofourmis RCM needs.
• Will work in collaboration with Clinical Compliance Officer to ensure all RCM practices meet regulatory requirements
• Will be the strategic leader for revenue cycle management including assisting with CPT strategy, bundle creation and execution, developing and optimizing a RCM workflow, being an expert on coding and documentation, and outlining key performance indicators critical to the success of Biofourmis claims-based billing.
• Assist in the creation and execution of all SOPs for RCM activities.
• Will be the strategic leader in registering and creating new practice locations (PLLC’s or Clients) within Biofourmis Athena platform.
• Will be in charge of maintaining the billing platform updated with any new and existing private payer contracts as well as any Federal payors (Medicare, Medicaid, VA). As well as completing all medical and provider group credentialing.
• Prepares month-end closing journal entries, reports, and balance sheet account reconciliations include balancing AR data as well as researching data discrepancies.

Contracting and Credentialing Job Duties & Responsibilities

• Along with senior managements approval manage all negotiations, pricing, and contracting renewals along with implementation and structure of the contracts within Biofourmis platform.
• Credential and contract practice with new possible managed care companies and or Medicare/Medicaid.
• Credential and contract practice’s employed providers aligning credentialing efforts with practices existing or new contracts.
• Create and maintain any new NPI state registrations required for any active states through the NPPES platform.
• Create and maintain practices organizational registration and specialty within payer portals.
• Assist any and all employed providers with CAQH’s credentialing database.
• Maintain a real-time record of existing contracts and potential opportunities by Biofourmis entity providing an insight to priority and targeted states/clients.
• Prepare and monitor a monthly report analyzing contract variances, monitoring closely overpayments or underpayments based on contracted payer rates and guidelines.

Requirements

• Bachelor’s degree in Health Administration, Finance, Accounting, Business, or related field; Graduate degree preferred.
• 10 years’ experience in healthcare organizations including a minimum of 5 years’ experience with oversight of a company’s RCM function
• At least 5 years’ experience of people management, ideally within a company setting that has experienced rapid growth (e.g. a startup that matured and went public)
• Experience working for or with an outsourced RCM vendor required
• Experience developing revenue cycle metrics and presenting KPIs to internal and external stakeholders
• Demonstrated experience with software application that can assist with RCM
• Strong understanding of data management and demonstrated experience developing process and workflow maps
• Demonstrated expertise on healthcare practice revenue cycles, including insurance verification, claims submission, payer reimbursement and error handling, patient co-pay and deductible collections, and denial management and recovery
• Demonstrated understanding of CMS policy guidelines and state regulations as they pertain to RCM activities, ideally with experience in remote patient management codes
• Experience with Electronic Medical Records systems (EMRs), ideally with Athena
• Strong leadership, collaboration, and communication skills
• Self-starter, able to wear multiple hats in a fast-paced, dynamic startup environment, often under ambiguous circumstances

Base compensation for this role is $95,000 - $130,000 depending upon experience.