BH Revenue Cycle Manager

GENERAL SUMMARY:

Manage and supervises the administrative functions, activities, and projects related to revenue cycle functions of the patient encounter and other non-clinical operations. Ensures maximization of revenue and cash flow while maintaining the highest levels of patient, physician, employee and other customer satisfaction. Includes but not limited to management oversight of all business-related functions of the patient encounter resulting in timely and accurate adjudication of the patient's account and electronic health record integrity. Specific areas of responsibility include supervision of Scheduling, Registration, Charging Process, Billing, Denials Management, Compliant Coding. Oversees either directly or indirectly the Medical Records processes as it relates to the Entities Clinic operations.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Serves as the expert for all Revenue Cycle processes for the entity. Provides overall vision and direction as well as developing goals for the Revenue Cycle team at the entity.

3. *Collaborates with the entities System Director of the Ambulatory Revenue Cycle in a matrixed leadership model with the entity leadership.

4. *Oversees and supervises thru their direct report, the Registration Manager, the scheduling and registration functions at the clinic and outreach locations. Ensures that accurate, timely and reliable information is being gathered and entered in the Electronic Health Record (EHR).

5. *Works with each Practice Manager to ensure a seamless registration and scheduling process in a matrixed relationship.

6. *Plans and directs registration, billing and collections, data processing to ensure accurate patient billing and efficient, timely account collection. Either directly or indirectly oversees the pre-authorization of patient insurance

7. Coordinates the exchange of information including medical record documentation to obtain and analyze additional patient information to document and process billing, respond to insurance inquiries, and manage liability accounts.

8. *Ensures proper coding processes and procedures; ensures training and competence of clinic staff processing charges; conducts regular coding audits.

9. In conjunction with the System Credentialing department oversees all the credentialing activities related to provider licensure, privileges, payer enrollment, liability coverage and overall professional history tracking.

10. *Responsible for denials management both inventory management and denial avoidance strategies.

11. In connection with the entity CFO and Bryan Health System Revenue Cycle departments, recommends updates for Charge Master items: evaluates fee schedules annually and adjusts Charge Masteraccordingly, ensures charging compliance, assists where applicable with cash posting, patient collections, patient complaints and financial counseling.

12. Develops and oversees the functionality and integrity of the practice management information system; works with information technology personnel to ensure timely and accurate administration of work processes within the system including the submission of electronic claims to third party carriers, claims logic development and maintenance, custom reporting and electronic remittance of third-party payments.

13. Oversees the departmental budgetary procedure to ensure proper operational and capital planning, appropriate and efficient use of resources, and consistent compliance to budgetary and fiscal controls.

14. Responsible for hiring, training, supervising, coaching, and evaluating all direct reports.

15. Works closely with clinic personnel and managers to monitor compliance to policies and procedures as they relate to the revenue cycle.

16. Participates in professional development activities and maintains professional affiliations within area of expertise.

17. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

18. Participates in and/or leads meetings, committees, strategic planning and department projects as assigned.

19. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk "*". Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Advanced knowledge and experience with current Revenue Cycle and EMR tools and technology.

2. Knowledge of performance improvement, budgetary and financial methods and practices.

3. Knowledge of third party and insurance company operating procedures, regulations and billing requirements, and government reimbursement programs.

4. Knowledge of medical information systems for billing and accounts receivable, spreadsheets, reporting applications, medical terminology, coding and office procedures.

5. Strong management skills and technical expertise and demonstrated by superior planning, decision-making, negotiation, leadership and financial acumen.

6. Skill in conflict diffusion and resolution and ability to perform crucial conversations with desired outcomes.

7. Ability to analyze problems, identify priorities and implement effective work strategies.

8. Ability to communicate effectively both verbally and in writing.

9. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.

10. Ability to prioritize work demands and work with minimal supervision.

11. Ability to make operational and management decisions in response to changing conditions.

12. Ability to manage multiple concurrent projects in a matrixed organization and expertise in developing complex systems and performance-based reporting.

13. Ability to maintain confidentiality relevant to sensitive information.

14. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:

Bachelor's degree in health administration, business administration, finance or related field required. Minimum of eight (8) years of progressively responsible leadership experience in revenue cycle within a health care environment required. Experience in a multi-facility leadership structure and EPIC preferred.

OTHER CREDENTIALS / CERTIFICATIONS:

None

PHYSICAL REQUIREMENTS:

(Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)

(DOT) - Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects.