Revenue Cycle Manager

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

MetroPlusHealth is embarking on a Core Processing System transition and is seeking a highly experienced Revenue Cycle Manager focused on leading a smooth transition from the functionalities provided by our existing homegrown billing application: Premium and Claims-Based Billing (Medicaid, HARP, MLTC, MAP, etc..); Commercial Billing; and Member Invoicing (CHP, QHP) including Spenddown. As part of this transition, the Revenue Cycle Manager will partner with our consultant to support the requirements gathering, process analysis, implementation and testing activities. They will understand current state processes and translate those into future requirements while ensuring that it aligns with the goals of the department. The manager will have a holistic understanding of the operational interconnections
of upstream/downstream billing processes and will collaborate with the consultant and cross-functional stakeholders that will result in detailed documentation illustrating end-to-end workflows and enhanced policies and procedures.

The Revenue Cycle Manager will collaborate with the Director of Revenue & Recovery to champion the broader vision of the future state Core Processing System and will be a key support in the flawless execution of the system transition, ensuring improved processes, accurate reporting, and revenue collection maximization.

• Oversee all billing processes in the Core Processing System (premium and claims-based billing, including stop loss/reinsurance).
• Serve as the main point of contact for the Billing workstream.
• In partnership in the Consultant and Director of Revenue & Recovery, confirm that the product roadmap includes all requirements for billing operations.
• Review all billing business requirements, workflow documentation, policies and procedures and confirm accuracy prior to sign off.
• Identify gaps and assist in identifying solutions for improvement.
• Assist in the testing and validation against established requirements to ensure all test cases and scenarios pass.
• During testing, identify deviations from requirements and partner to remedy issues.
• Contribute to the development of training materials.
• Support business process, training, and change management efforts by providing insights and feedback.
• Ensure timeliness of all deliverables outlined in the project schedule.
• Act as a liaison between the Consultant, business stakeholders, development teams, and other critical resources, facilitating effective communication and alignment.
• Prepare comprehensive reports to track revenue by synthesizing multiple databases.
• Ensure maximizing revenue potential by preparing various analyses.
• Contribute to day-to-day operations.
• Other duties as assigned.

• Bachelor's Degree in related field required. Master's Degree preferred.
• Proven experience (8+ years) in health insurance billing operations.
• Proven track record of successful collaboration with development teams to deliver high-quality output and reports.
• Experience in core processing system migration.
• Expertise in revenue cycle management principles, best practices, and revenue cycle performance indicators. NYS experience highly desirable.
• Proficiency in eliciting, documenting, and managing business and functional requirements.
• Excellent analytical and written skills with the ability to synthesize complex information and provide actionable insights.
• Knowledge of New York State health plan industry regulations, guidelines, requirements and policies.
• Expertise in SQL and Excel. Proficiency in Microsoft Windows and VISIO.
• A satisfactory equivalent combination of education, training and experience.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication

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