Job Description
Reporting directly to the Operations Manager, this position is responsible for all day-to-day billing and revenue cycle processes of the organization. This includes providing primary oversight of our contracted revenue cycle management (RCM) provider(s), collaborating closely with departmental staff and clinical providers to assure optimum billing performance. The following list of responsibilities are intended to describe the general nature and level of work to be performed in this position -- it is not intended to be an exhaustive list of all duties, responsibilities and skills required.
Primary Duties & Responsibilities:
* Responsible for entire revenue cycle from scheduling, appointments, surgery scheduling to correct coding, charging, billing, collections and denial management.
* Responsible for management and maintenance of billing and practice management software platform
* Establish training standards for both new and existing employees and implement regularly scheduled classes.
* Coordinate all necessary training when necessary for new software functionality or system upgrades.
* Manage relationships with external RCM vendors responsible for RCM functions.
* Analyze daily, weekly and monthly reports presented by RCM vendors and identify opportunities for work process improvements; implement as necessary.
* Analyze appeal reports, tracking work effort by the RCM vendors to ensure collections activity on a regular basis. Review EOBs as needed to determine/address payer problems.
* Work closely with the practice's RCM vendor(s) to ensure all denials are managed timely; analyze the root cause of such denials and implement corrective action plans as necessary.
* Drive process improvement initiatives related to front end revenue cycle functions, in collaboration with the clinical and operations leadership.
* Ensure that front-end systems and processes across all locations are designed and implemented appropriately to maximize customer service, staff efficiency and revenue capture. This may include systems and processes for registration, scheduling, check in / check out, referral management, point of service collections, and more.
* Coordinate professional coding of all encounters and procedures. Implement and monitor appropriate processes to ensure timely receipt of operative reports, prompt coding and charging of such cases.
* Responsible for negotiating payer contracts, which includes development, evaluate, negotiate and implement agreed upon fee schedules. Create and maintain relationships with provider representatives at insurance companies. Develop a communication tool for reference highlighting basic facts about specific payers such as the number of days to timely filing. Will monitor and communicate to providers and operations the performance of contracted payers.
* Ensure that fee schedules and payor contracts are properly loaded into the PM software; establish and manage variance reporting processes and resolution of underpayments and overpayments.
* Serve as a key resource for changes in payment and coding guidelines from all payors; educate and reeducate staff and providers on these continual updates and ensure that RCM system edits are updated as necessary to ensure clean claim submission.
* Meet with senior clinical leadership regularly to provide updates on the RCM vendor performance and overall revenue cycle health and make recommendations for organizational change, where necessary.
* Perform other duties within the scope of the practice's revenue cycle as assigned.
Required Skills & Experience
o 5+ years management experience
o Strong experience level with Athena and ERCM's
o Experienced in revenue cycle management in a private practice healthcare setting -- specialized only, no primary care
o CPC certified
o Strong understanding of state and federal compliance and laws
o Comfortable hiring, firing, doing reports, growing teams
o Fantastic communicator, highly professional, able to get in the weeds with team and still execute at a high level with board members
Nice to Have Skills & Experience
Otolaryngology (ENT) Practice experience
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.