SUMMARY:
The Revenue Cycle Manager is responsible for all aspects of the health billing cycle, including documenting eligibility, coordinating credentialing, preparing and submitting invoices, payment posting, recording in financials, resolving denials, editing failures, and problem-solving with payers. Types of billing include private insurance, individual, Medicaid, and Medicare. The person in this position is responsible for clear, detailed communication with the clinical staff, payers, and clients regarding eligibility, billing, and payment-related issues. Other responsibilities will include researching and resolving disputed and uncollected claims and invoices by working closely with the clinical staff members and payers.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Create and design processes, workflow, and systems to ensure quality, effectiveness, and efficiency, identify resource impact, and lead and facilitate process improvements.
- Manage billing process workflow across programmatic and finance departments.
- Provide strategic direction and lead innovations and operational enhancements/standardization by leveraging best practices and technology to create best-in-class billing operations.
- Coordinate and input information in prescribed systems for billing, recording, payment posting, and claims processing.
- Interact with staff, clients, payers, and agencies to answer questions, obtain information, and resolve issues related to eligibility, credentialing, and billing.
- Assist the administrator for the Electronic Health Record (CareLogic) on identifying and resolving issues along with training and optimal configuration.
- Develop a comprehensive strategy to respond to current and future government policies to monitor and address changing revenue cycle practices as they relate to successful claim adjudication.
- Troubleshoot EHR technical issues as they come up and engage CareLogic technical assistance as needed.
- Develop policies and procedures for billing and access EHR system users, as well as providing training and producing technical literature.
- Conduct compliance trend analyses from system reports, identifies gaps, and develops program components to mitigate identified gaps.
- Monitor aged receivable reports and take all steps necessary to ensure payment of claims. Coordinate development of business rules surrounding collection of unpaid amounts.
- Coordinate and collect necessary information from staff or payers for claims adjudication.
- Obtain and input into required system pertinent documents such as payer agreements and other such ancillary documents as may be necessary to support transactions.
- Coordinate business rules surrounding take-back, overpayment, and refund processes.
- Recognize problem accounts and escalate to appropriate staff to assist with resolution.
- Maintain current knowledge on billing compliance requirements with all internal, federal, state, and local regulations governing rendered patient services. Lead or participate in training with staff on requirements.
- Assist in the creation of policies and procedures related to billing.
- Participate in chart opening and auditing processes as needed.
- Responsible for accurate, timely recording and submission of claims with appropriate data elements within prescribed timeframes.
- Posting and reconciling Explanation of Benefits and Explanation of Payment forms.
- Responsible for accurate, timely posting and reconciliation of payments to billing amounts.
- Participate in the appeals and grievances processes as requested.
- Serve as liaison with IT staff to ensure security of transactions and compliance with HIPAA regulations.
ADDITIONAL DUTIES AND RESPONSIBILITIES:
- The ability to work independently and collaboratively on projects.
- Accomplishes all tasks as appropriately assigned and requested.
- This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the position. Other duties as assigned; responsibilities and duties may change, or new ones may be assigned at any time with or without notice.
- Embraces Culture, Diversity, Equity, and Inclusion – Demonstrates a personal commitment to valuing different backgrounds and life experiences through word and action. Takes personal actions to build an inclusive culture that ensures everyone can fully contribute based on their unique talents, skills and perspectives and feels welcomed and valued. Commits to driving equitable solutions to address root cause issues by incorporating an equity framework in their daily work.
- Respectfully interacts with a multicultural and diverse workforce. Speaks positively of Volunteers of America Southeast Louisiana to clients, the public and co-workers. Expresses support of VOASELA and management initiatives when interacting with employees or clients.
SUPERVISORY RESPONSIBILITIES:
QUALIFICATIONS and COMPETENCIES:
To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The Revenue Cycle Manager should possess experience in coding, billing, posting, and adjudication of claims. Specialized experience in behavioral health billing services is required.
- The ability to create channels of communication to obtain information necessary to perform job tasks, such as with clients, payers, and clinical staff.
- The ability to recognize individual and system problems and to communicate such information to the appropriate parties.
- Outstanding attention to detail and excellent time management skills. This position requires mastery of a large amount of detail.
- Experience, Competencies and Education:
The position requires a BS or BA in healthcare, business, or a related concentration. Requires a minimum of five years of progressive experience in a healthcare billing environment. Relevant experience could be considered in combination or in lieu of the educational requirement.
Must have excellent written and verbal communication skills and abilities and be able to communicate appropriately and effectively in sensitive and/or demanding situations. Must demonstrate the ability to represent Volunteers of America, and effectively interact with multi-cultural and diverse populations.
- Other Skills and Abilities:
Outstanding computer skills with billing applications, Microsoft Word, and Microsoft Excel; organize and prioritize work, time management, meet deadlines and operate office equipment. Position requires work schedule flexibility.
AMERICANS WITH DISABILITY SPECIFICATIONS:
- Physical Demands: While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to sit; occasionally required to stand, walk, use hands requiring manual (finger) dexterity, reach with arms and hands, climb or balance, stoop, kneel, crouch, crawl. The employee may from time to time be required to lift and/or move up to 10 pounds. Specific vision abilities required include close vision, distance vision, depth perception, and the ability to adjust focus.
- Work Environment: Typical office environment with moderate noise; the pace and demand for multitasking, can become hectic at times. Position may require work schedule flexibility to attend special events on occasion, with requisite travel to and from those events.
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