Key Responsibilities:

Revenue Cycle Operations Oversight

Lead end-to-end revenue cycle functions, including claims submission, charge capture, billing, payment posting, denial management, and collections, ensuring accuracy and compliance with industry regulations.

Establish and maintain efficient workflows for each step of the revenue cycle, prioritizing high-quality service and prompt resolution of claims to minimize AR aging.

Monitor revenue cycle metrics and KPIs, such as clean claim rate, denial rate, and AR days, ensuring optimal financial performance and adherence to client service standards.

Denial Management and Claims Resolution

Oversee the claims denial management process, developing strategies to prevent denials, reduce denial rates, and improve overturn rates on appealed claims.

Collaborate with coding, billing, and follow-up teams to identify patterns in denials and implement corrective actions to reduce recurring issues.

Ensure timely and accurate claims resolution, working with insurance companies and clients as necessary to address and resolve complex claims.

Team Leadership and Development

Lead, coach, and develop the RCM team, providing training and mentorship to improve team performance and ensure alignment with department goals.

Set team goals and objectives aligned with organizational targets, regularly reviewing team progress and providing constructive feedback.

 Foster a collaborative team culture focused on client satisfaction, efficiency, and professional growth, with opportunities for skill enhancement in RCM processes and client relationship management.

Client and Stakeholder Communication

 Serve as the primary point of contact for clients regarding revenue cycle performance, addressing client inquiries, providing status updates, and delivering data-driven insights.

Conduct regular client meetings to review RCM performance, address concerns, and provide recommendations for improving collections, payment posting, and AR management.

Collaborate with other departments, such as coding and compliance, to ensure cohesive and effective revenue cycle operations.

Process Improvement and Compliance

Continuously analyze and optimize revenue cycle workflows to improve efficiency, reduce AR aging, and increase revenue capture, utilizing data and feedback from clients and staff.

Ensure compliance with federal, state, and industry regulations governing claims processing, billing, and collections, maintaining a high standard of data security and patient confidentiality.

Stay informed about industry trends and best practices, implementing relevant changes to enhance the organization’s RCM services.

Qualifications:

Education: Bachelor’s degree in healthcare administration, Business, Finance, or a related field or relevant certification (e.g., CRCR, CPC) preferred.

Experience: 5+ years of experience in revenue cycle management, with at least 2 years in a management or supervisory role. Extensive knowledge of claims processing, denial management, and AR follow-up is essential.