Revenue Cycle Manager/Billing Manager
The purpose of the Revenue Cycle Manager is to develop, plan, organize and implement current and future strategies for patients, along with processing payments, minimizing bad debt, improving cash flow and for managing the overall health of the patient’s receivables. This role is also responsible for managing the client’s day to day activities as it relates to full revenue cycle functions.
Must possess a comprehensive knowledge of revenue cycle functions and systems, including specific experience within the area of revenue management and functional areas of billing/follow-up. Plans and directs patient insurance documentation, workload coding, billing/collections and data processing to ensure accurate billing and efficient account collection. Demonstrates ability to interpret 3rd party payer contract requirements and recommend, design and implement procedures for compliance with regulations and standards. Analyzes billing and claims for accuracy and completeness; submits claims to proper insurance entities as necessary and follows up as needed. Prepares and analyzes accounts receivable reports and other financial reports as needed. Perform on-going monitoring and auditing of areas assigned to ensure appropriate documentation, coding, charting, etc. Coordinate 3rd party audits and denial management processes, including tracking trends and responding with potential process improvements to reduce future denials.
Medical credentialing: Oversees the provider credentialing function for the practice, including DEA, CDS, Medical Licenses, Board Certificates, Malpractice Insurance Face Sheets, etc.). Acts as the liaison between the practice and the insurance carriers and hospitals with all matters relating to the credentialing / re-credentialing process. Establishes close working relationships with privileging coordinators, contracting department, medical management, and payer contacts. Understands specific application requirements for each payer including prerequisites, forms required, form completion requirements, sup-porting documentation and CMS/Medicare guidelines.