Revenue Cycle Manager

The Revenue Cycle Manager (“RCM”) will work under the general supervision of the Director, Business and Clinic Operations. This position is responsible for ensuring that patient billing and processing of payment receipts are consistently completed timely and in accordance with policy. The RCM will minimize bad debt, improve cash flow and effectively manage accounts receivables. This position will coordinate effective management of revenue cycle activities across the organization to include, but not limited to front desk, out-patient billing, hospital billings, collections, financial counseling for patients, staff and physician training.

• Supervise and evaluate support staff personnel to include, but not limited to, front desk (both check-in and check-out), scheduling staff and referrals staff members in a timely manner.  
• Ensure accuracy of deposits, demographic and other information entered into the electronic healthcare records.
• Participate in program/service evaluation activities; facilitate changes in provision of service based on Continuous Quality Improvement results (i.e. MIPS and HEDIS).
• Compile and prepare various status reports for management in order to analyze trends and make recommendations.
• Participate in preparation of monthly, quarterly and annual financial reports.
• Monitor data integrity for the practice management system to include reconciliation of charges and collections. Report problems to the Director, Business and Clinic Operations and Chief Medical Officer or other appropriate personnel in a timely manner.
• Provide a monthly summary on the status of outstanding charges greater than 90 days in the Accounts Receivable Aging report.
• Provide monthly report on the status of credit balances. (Unapplied Credit Analysis Report)
• Monitor gross charges to determine the potential need for an update to the fee schedule on at least an annual basis. Report findings and recommendations to Director, Business and Clinic Operations and the Chief Financial Officer.
• Coordinate with the Director, Business and Clinic Operations to stay current on credentialing issues, especially in the case of new providers, with an emphasis on scheduling mainly self-pay patients and Medicare for the new providers until they are credentialed with third party organizations.
• Monitor volume of charge and collection posting on a monthly basis to confirm that all encounters for out-patient and hospital are being entered in a timely fashion.
• Responsible for ensuring the timeliness of processing and correction of rejected claims.
• Maintain rosters of Managed Care patients for all plans which have been active within the two most recent calendar years.
• Work closely with the third-party billing entity, and/or in house billing personnel, to maintain a regular schedule for sending out billing statements in accordance with the Financial Policies and Procedures.
• Work closely with the third-party billing entity, and/or in house billing personnel, to maintain and process for review of all billing statements which are returned to sender. Utilize public records and other resources to make best effort to obtain accurate billing addresses.
• Maintain a regular schedule for writing off bad debts, including a process which documents attempts to collect or resubmit prior to removing the charge from outstanding receivables. Submit Bad Debt Write Off Report to CFO.
• Monitor coding practices among providers to determine potential patterns of under coding or other irregularities.
• Keep third party billing agency, and/or in house billing personnel, up to date on third party coverage contracts, assuring that current contractual terms are understood and applied correctly.
• Establish and maintain a regular process for follow up on patient accounts which are pending approval for third party coverage.
• Maintain current information for billing and collections processes for each third-party carrier in a Billing Manual.
• Work with Practice Managers and Schedulers/call center to assure that patients are informed of requirements such as income and/or insurance verification at the time that the appointment is scheduled. Confirm that patients who have coverage that is not accepted at our organization are made aware of this fact before appointment is scheduled.
• Review patient financials for self-pay patients in accordance with the TUMG Financial Assistance Policy to determine eligibility and their payment schedule.
• Assure that the need for any referrals and/or authorizations are addressed at the time of scheduling the appointment.
• Maintain process for verifying insurance at the time of each billable patient encounter.
• Monitor and identify any patterns in remittance advices which would indicate. employees are not properly collecting insurance information. In coordination with Director, Business and Clinic Operations, initiate retraining and/or other corrective action indicated.
• Maintain a process of coverage verification for scheduled patients prior to appointment.
• Coordinate the Revenue Cycle Management team to address any deficiencies in healthcare providers and staff performance uncovered by internal audits.
• Must hold all patient Protected Health Information (PHI) and other patient personal information and agency information in confidence, in accordance with the Employee Confidentiality Statement, which you have read, understand and signed.
• Actively participates in and complies with all aspects of the Corporate Compliance Program, follow the Program Code of Conduct and obey all relevant laws, statutes, regulations and requirements applicable to Medicaid, Medicare and other State and Federal health care programs.
• Participate in CQI, other internal committees, special projects/observances or activities that promote improvements in organizational performance and/or advance the mission, goals and objectives of Touro University Medical Group.
• Adhere to schedules for work, lunch and breaks.
• Perform any other duties as assigned.

SUPERVISORY RESPONSIBILITIES (if applicable): should reflect who the employee is supervising and what the expectations are.

• Functions with minimal direct supervision.
• Must have at least 5 years of progressive experience in medical billing.
• Must be dependable and conduct him/herself in a professional manner.
• Demonstrates skill in use of personal computers, various programs and applications required to competently execute job duties.
• Demonstrates effective management skills, with the potential to oversee an internal billing department.
• Has knowledge of quality management process.
• Demonstrates ability to establish and maintain effective internal and external working relationships.
• Must demonstrate an above average ability to communicate effectively both orally and in writing.
• Must demonstrate the ability to exercise sound judgment and discretion.
• Must have strong financial management knowledge and experience.
• Must be an effective communicator with strong oral, written and presentation skills.

Knowledge, Skills and Abilities:

• Excellent verbal and written communication skills
• Excellent interpersonal, negotiation, and conflict resolution skills
• Excellent organizational skills and attention to detail
• Strong analytical and problem-solving skills
• Ability to prioritize tasks and to delegate them when appropriate
• Ability to act with integrity, professionalism, and confidentiality
• Familiar with billing and financial related laws and regulations
• Proficient with Microsoft Office Suite or related software
• Experience with Electronic Health Records
• Proficiency with or the ability to quickly learn the organizations human resources management platform and talent management systems
• Ability to delegate responsibly to others, activities according to ability, level of preparation, the standards of practice, the scope of practice and regulatory guidelines
• Ability to develop programs and lead process improvement projects
• Participate in strategic planning as requested by Leadership
• Ability to initiate and implement change conducive to the improvement of the quality and safety of patient care delivery
• Ability to provide leadership, influence others to meet patient needs and achieve shared goals, to effectively prioritize system resources, promote cooperative behaviors, act as a role model, resource and mentor
• Ability to supervise, coach, mentor, train, and evaluate work results
• Keeps abreast of developments in technology to communicate, manage knowledge, mitigate error, and support decision-making
• Awareness of current theories, principles, practices, standards, emerging technologies, techniques and approaches in the health care system, and the responsibility and accountability for the outcome of practice
• Knowledge of laws, rules and regulations; standards and guidelines of certifying and accrediting bodies
• Knowledge of principles and practices of organization, administration, fiscal and personnel management essential to the operation of the clinic