Revenue Cycle Manager
Department: Health Systems
Program: Health Systems
Reports to: Health Systems Director
Supervises: Revenue Cycle Technician *2
Employment Status: Full-Time
FLSA Status: Exempt
Schedule: Exempt
Preference: TERO Ordinance 2017-01, P.L. 93-638
Job Summary
The Revenue Cycle lead will be responsible for Health Care billing and coding for the Kenaitze Indian Tribe. This position serves as the point of contact and liaison between management and the third-party billing contractor. Major functions include, but are not limited to, coordinating billing and collection activities, maximizing payments, performing audits, and process improvement.
Essential Functions
- Coordinates billing and collection activities between providers and third-party billing contractor.
- Monitors accounts receivable for revenue leakage; oversees and monitors compliance with healthcare billing coding regulations.
- Tracks, analyzes, and reports healthcare revenue cycle performance targets.
- Assists billing contractor in credentialing and enrolling providers with all insurance.
- Monitors denials and reasons; understands payer's EOB and the activities of registration and admission departments for errors.
- Ensures the third-party contractor is accurately billing claims timely.
- Works closely with the third-party billing and coding contractors to find issues that prevent claims from going to the payor.
- Sets A/R Goals for the third-party contractors; works closely with department directors/managers to minimize errors that prevent claims from processing.
- Ensures compliance with Tribal, federal, state, and local employment laws and regulations, Tribal policies, and TERO ordinance.
It is the intent of this job description to highlight the essential functions of the position; however, it is not an all-inclusive list. The incumbent may be called upon and required to follow or perform other duties and tasks requested by his/her supervisor, consistent with the purpose of the position, department and/or the Kenaitze Indian Tribe's objectives.
Working Conditions
Lifting Requirements
- Sedentary work - Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
Physical Requirements
- Stand or Sit (Stationary position)
- Walk (Move, Traverse)
- Use hands/fingers to handle or feel (Operate, Activate, Use, Prepare, Inspect, Place, Detect, Position)
- Stoop, kneel, crouch or crawl (Position self (to), Move)
- Talk/hear (Communicate, Detect, Converse with, Discern, Convey, Express oneself, Exchange information)
- See (Detect, Determine, Perceive, Identify, Recognize, Judge, Observe, Inspect, Estimate, Assess)
- Repetitive Motion
OSHA Categories
- Category III - Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.
Equipment and Tools
List Equipment used for job: Computer, scanner, fax, copier and other office equipment.
Travel
Qualifications
Education
- Bachelor's degree in finance/accounting, health care management, business administration or related field, or a combination of education and experience in a related field may be substituted for a degree.
- 5 years of Health Care experience preferred. Patient access, Billing and Coding.
- Extensive knowledge between Admitting, Clinical Areas, Coding and Financial Areas.
Experience
- Five (5) years' experience in management of the healthcare revenue cycle.
- Experience in accounting for healthcare revenue recognition and financial statements.
- Experience working with Medicare, Medicaid, and other payors.
- Must be able to understand Alaska Medicaid billing guidelines.
- Knowledge of computer systems in Cerner, MyEvolv and Dentrix.
- Must be able to understand denials and reasons, and payer's EOB.
- Strong understanding of Revenue Cycle Management and Regulatory Agencies.
- Experience in Federal and State regulatory associated to billing/collections.
- Exceptional knowledge in Patient Access/Scheduling and authorizations.
- Must be able to receive and express detailed information through oral and written communications.
- Excellent interpersonal and organizational skills.
Preferred
- MHA, CPA, or equivalent advanced degree.
- E.H.R. system administration role with CERNER, Dentrix, or MyEvolv.
- Healthcare Financial Management Certification.
- Advanced skills with Microsoft applications including Word, Excel, and Outlook.
- Knowledge and experience working with cultural diversities.
License/Certification
- Must have a valid Alaska State driver's license and must remain insurable under the Tribe's policy or obtain within 90 days of hire.
Special Skills
- Knowledge of Medicare, Alaska Medicaid, and third-party payer regulations and how to work within their guidelines.
- Advanced technical, analytical, problem-solving, and project management skills demonstrated through prior professional experience.
- Remains current on healthcare industry practices and government rules to predict/inform revenue cycle impact.
- Thorough understanding of the healthcare revenue cycle process, including staff roles and responsibilities, work requirements, and best practices.
- Proficiency in the use of computers, E.H.R, office productivity software, and health practice management applications.
- Ability to prioritize multiple projects and deadlines.
- Proven organizational and time management skills.
- Ability to work independently as well as collaboratively.
- Conducts business in a service-oriented manner that is attentive, pleasant, respectful, and kind when dealing with un'ina, visitors, co-workers, and others.
This position is a Covered Position subject to all requirements of the Alaska Barrier Crimes Act (ABCA) and to the Indian Child Protection and Family Violence Prevention Act, (ICPA). ABCA and ICPA requirements apply and must be complied with at all times in order to remain in the position.
*Memorandum of Understanding: Serves as documented evidence that the Kenaitze Indian Tribe has expressed the ineligibility of an employee to operate motor vehicles owned, leased or rented by the Kenaitze Indian Tribe, or to operate a personal vehicle on behalf of the Kenaitze Indian Tribe.
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