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Job Family Summary :
The Revenue Cycle Department is responsible to manage all aspects of claims management including Onsite operations and back-end processing. The department primarily works on main objective of reducing cost and increasing revenue through the optimization of processing and timely submission of claims in time with highest quality, so to ensure the client receives the payment with minimal or no rejections.
Role Summary :
The Manager, Revenue Cycle, is responsible to manage all aspects of claims processing throughout the claims cycle including Onsite operations and back-end processing. Manage overall activities of the onsite operation including compliance of hospital staff with using BMS real time and compliance with notification of IP admissions and discharges. Ensures that timely submission of approvals and timely detection and obtaining of approval extension, daily IP coding, timely closing of IP and OP encounters and forward to billing system at the back office.
The roles primary objective is to reduce operating cost while ensuring a smooth and swift movement of the claim through its cycle up till submission to payer. Improving productivity and reducing TAT through the optimization of processes and systems is the key scope of this role.
The Revenue Cycle Manager will contribute to the day-to-day operations on all issues related to the revenue cycle function, provide analysis, create written processes and train others in implementing a cross functional revenue cycle team.
Primary Responsibilities :
Support the Cluster Director in Revenue Cycle Activities
Assists with the development and implementation of revenue cycle strategies, processes and improvements initiative to continuously improve the RCM process to maximize billing and collections
Coordinate with Revenue Cycle supervisors and managers to ensure efficient claims submission and payment processes Internal Audit of specified High value and High Risk claims with focus on Compliance and Revenue Optimization Update staff and the client on Regulator guidelines related to RCM billing activities and protocols to be followed.
Ensures the implementation of Key Performance Indicators (KPIs) with focus on reducing turnaround times and increasing productivity with Quality metrics achieved Ensure communication to respective doctors all medical necessity related denials and prepare effective plans to prevent such denials in future.
Conducts RCM training to onsite staff in various RCM functions as and when required.
Actively monitors operational performance to anticipate and meet the needs of leadership. Ensure KPI's within the team is established and instills accountability and ownership at the appropriate level
Develop audit reports on productivity to ensure all processors are able to meet and exceed their productivity targets
Reviews and monitors all revenue cycle interfaces to identify issues and barriers to an effective revenue cycle process. Recommends and helps implement solutions. Leads and/or participate in other revenue cycle projects as assigned. Reviews and maintains familiarity with payer contracts for the assigned clients/clusters
Ensures all revenue cycle policies and procedures are created and updated regularly and ensures the information is distributed to and understood by all staff.
Compile and analyze data for billing errors and work on solutions to reduce billing errors.
Develops direct reports by defining roles/responsibilities and expectations, assigning and communicating performance and promoting professional growth and accountability. Assists team in communicating and aligning work priorities with the organizational vision, mission, values, and service standards
Any other tasks related to Revenue optimization and billing.
Exercise discretion and independent judgement with respect to matters of significance.
Job Requirements :
Clinical Background or paramedic by education / Masters degree in healthcare administration preferred
CPMA/ CCS/ CPC/COC certified (Coding certification) Proficient in coding all out patient type charts
ICD 10 CM/CPT experience and knowledge is a must
Ability to take direction from all levels
Exhibit a high level of individual initiative.
Effectively lead a team environment.
Candidates must also have good problem-solving skills and excellent oral &written communication skills [ Bilingual preferred]
Prior leadership experience
Revenue cycle consulting experience, such as revenue cycle outsourcing, interim management or performance improvement preferred
5 years of claims processing experience in large healthcare or Health insurance operations
Experience working with project stakeholders/business leadership team
Proficient in Healthcare Revenue Cycle programs and Technology
Key Performance Indicators (KPI's):
Core KPIs
Reduce overall Turn Around Time by ____%
Increase productivity by _____%
Additional KPIs
Achieve 100% timely submission every month for assigned clients
Analyze, control and implement actions to minimize or eliminate Revenue Leakage for the assigned clients/cluster.
