Revenue Cycle Manager

Description

SUMMARY:

The Manager, Revenue Cycle manages and oversees the authorization, coding, billing, claims and collections for the Company. The Manager, Revenue Cycle is responsible for maximizing the productivity and minimizing the errors of the Revenue Cycle Department using structured auditing and reporting methodologies combined with follow-up training. The Manager, Revenue Cycle will assume a strategic and practical role in the finance department to include day-to-day responsibility for billing processing and strategy, planning, management and analysis, and policy development.

ESSENTIAL FUNCTIONS:

To perform this job successfully, an individual must be able to perform each essential function satisfactorily with or without accommodation. The requirements listed below are representative, but not all inclusive, of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions. 

• Full revenue cycle management of the organization.
• Oversees the day-to-day activities of the authorization, invoicing and collections department.
• Oversees denials management, including reporting, accountability and resolution.
• Protects confidentiality within the parameters of federal guidelines and established policy and process as well as compliance with payer and provider contracts.
• Leads in development and implementation of policies/procedures to assure compliance with new regulatory standards affecting billing/revenue.
• Managing, training, and coaching individual team members, including creating personnel development and succession plans and partnering with HR as needed to maintain an engaged and productive team.
• Summarizes and communicates revenue cycle successes, challenges, and trends to the executive team.
• Creates and implements metrics for productivity and quality.
• Creates, develops, and implements Standard Operating Procedures (SOP), streamlines processes.
• Collaborates with the Finance team to manage the month-end close and annual audit processes.
• Other duties as assigned by management.

Requirements

QUALIFICATIONS:

REQUIRED: Bachelor’s degree in Business, Finance, Accounting, Healthcare Administration or equivalent. Minimum 5 years of billing experience. Minimum 3 years of management experience; experience managing subordinates and teams. Experience with working in an integrated health care system required. Must have experience and be A/R oriented, daily and monthly closings, and understand the revenue cycle for all payers. Demonstrated knowledge of all Insurance companies, HMO's, PPO's, Medicare, third party payers. Directly overseeing payer and provider billing, collections, and cash posting. Facilitating communication between and extracting relevant information from a variety of stakeholders in order to comprehensively identify problems and subsequently create sustainable and scalable solutions.

DESIRABLE: Master’s degree in Business, Finance, Accounting or Healthcare Administration. Considerable prior coursework or on-the-job training in ophthalmology, insurance, and management. Knowledge of Word, Excel, PowerPoint, CareCloud.

CERTIFICATES/LICENSES/REGISTRATIONS:

• Revenue Cycle Certification (desired, but not required).

KNOWLEDGE/SKILLS/ABILITIES/TALENTS:

• Ability to optimize the Revenue Cycle (through the team members, operational processes and detailed data analysis). 
• Results driven; aligns and allocates time and energy on key drivers. 
• Understands key metrics, revenue drivers, and ROI expense analytics.
• Strong research and auditing skills. Can analyze financial information and determine impact on the business.
• Ability to identify and resolve issues in a timely and proactive manner.
• Clearly communicates vision and aligns team members around it; Recognizes and celebrates success.
• Identifies, develops and promotes potential Leads/Supervisors, and ensures that direct reports similarly develop their employees.
• Provides continual, direct feedback; provides employee coaching vs. directing.
• Appropriately delegates authority and responsibility and holds team members accountable.
• Ability to develop trusting, mutually-respectful relationships with professionals/clinicians. 
• Strategic Planner; sets realistic monthly, quarterly, and annual objectives.
• Measures and communicates monthly results; prioritizes work and time/schedule to achieve business objectives.
• Plans ahead (6-12months) to anticipate and overcome potential obstacles to success.
• Effective Collaborator with Peers and Support Resources.
• Innovates and analyzes to improve operational processes.
• Detail oriented, organized, process focused, problem solver, self motivated proactive, customer service focused.
• Displays independent judgment by willingness to make timely and accurate decisions based on available information that is sometimes vague or limited in nature.    
• Ability to multitask effectively and work in a fast paced and sometimes ambiguous environment, without compromising quality of work.
• Ability to prioritize tasks and projects with limited direction, while understanding and contributing to the success of the organization.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. 

• This is primarily an office classification. Temperature conditions are controlled with limited direct exposure to hazardous physical substances. The noise level in the work environment is usually low to moderate.
• While performing the duties of this job, the employee is regularly required to sit, stand, walk, handle, or feel, reach with hands and arms, see, talk and hear. The employee will frequently lift and/or carry reports, records and other materials that typically weigh less than 20 pounds. The employee is occasionally required to stoop, kneel, bend, or crouch. 
• Finger dexterity is needed to access, enter, and retrieve data using a computer keyboard, calculator, and other standard office equipment.

All of the information contained herein reflect general details as necessary to describe the principal functions of this classification, the level of knowledge and skill typically required and the scope of responsibility, but should not be considered an all-inclusive listing of work requirements. Management reserves the rights to add, modify, change, or rescind the duties and/or work assignments of all positions, without advanced notice, and to make reasonable accommodations so that qualified employees can perform the essential functions of the job.

Notwithstanding any of the foregoing described job responsibilities, employee shall not engage in activities that constitute the practice of ophthalmology as prohibited under applicable law. Employee shall neither exercise control over nor interfere with the clinician-patient relationship. Clinicians shall have sole responsibility for all professional services provided to patients.

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THIS JOB DESCRIPTION AND THAT I HAVE BEEN GIVEN AN APPROPRIATE ORIENTATION, AND THAT I AM QUALIFIED, CAPABLE OF AND PREPARED TO FULFILL THE DUTIES AS ASSIGNED.

Print Name: _____________________________________________ Date: __________

Signature: ________________________________________________________