Revenue Cycle Manager/ Pre-Certification-REMOTE

Employment Type: Full Time

REMOTE Position- Eastern Standard Hours

Benefits: M/D/V, Life Ins., 401(k)

Teaneck, New Jersey

SCOPE: Manages the front office revenue cycle processes for multiple sites within a practice. Oversees intake, insurance verification, charge capture and charge entry processes for compliance with federal and state regulations, as well as payer guidelines. Coordinates with office manager and front office coordinators to ensure optimal revenue cycle processes and adherence to The US Oncology Networks policies and procedures. Supports and adheres to The US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

The US Oncology Network: Join us at Regional Cancer Care Associates (RCCA), where our dedicated oncologists and hematologists blend expertise with compassion to deliver the advanced care you deserve for cancer and blood disorders. Since joining The US Oncology Network in 2023, we've strengthened our commitment to excellence with state-of-the-art clinical and business support services. These resources empower local practices to lead in providing efficient, top-quality care while enhancing the quality of life and financial security for our physicians. Be a part of our team and make a difference in the fight against cancer!

About The US Oncology Network
The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care. For more information, visit www.usoncology.com. We extend an extremely competitive offering of benefits to employees, including Medical Health Care, Dental Care, Vision Plan, 401-K with a matching component, Life Insurance, Short-term and Long-term disability, and Wellness & Perks Programs.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Oversee the Eligibility and Pre-authorization teams for Oncology treatments and oral pharmacy services, ensuring all patient eligibility is verified accurately and promptly.
• Function as a liaison between Central Business Office, physicians, and practice sites to resolve accounts receivable issues and questions.
• Develop and maintain relationships with insurance providers to facilitate efficient eligibility verification processes and pre-authorization submissions.
• Collaborate with healthcare providers to gather necessary documentation required for pre-authorization and ensure timely approval of oncology treatments and oral pharmacy prescriptions.
• Implement and oversee technology solutions to streamline eligibility checks, pre-authorization processes, and reduce manual errors.
• Monitor and report on pre-authorization approval rates and turnaround times, identifying areas for improvement.
• Coordinate with the billing department to ensure that pre-authorized treatments are billed correctly and in a timely manner.
• Conduct regular audits to ensure adherence to internal policies and external regulations, staying informed about changes in healthcare regulations related to oncology and pharmacy services.
• Assist in the development and implementation of training programs for corporate and practice employees, including training on eligibility and pre-authorization procedures, to improve A/R and billing functions.
• Maintain a working knowledge of applicable laws and regulations as they relate to assigned responsibilities and communicate regulatory and industry standards to employees.
• Conduct audits to ensure compliance and monitor productivity in the A/R, eligibility, and pre-authorization functions.
• May coordinate facilities and office management functions including payroll submission.
• Supervise, through multiple subordinate supervisors, teams of employees involved in the Pre-authorization and eligibility of Accounts Receivable for the Central Business Office.
• Provide on-going front-office process review and implement process revisions as needed.
• Coordinate and or provide training for new front office staff, and retraining as needed.
• Super User of Practice Management System and interfaced systems.
• Ensures roll-out of System updates to front-office team.
• Chairs Revenue Cycle Front Office task teams. Co-chairs C2C Committee.

MINIMUM QUALIFICATIONS:

• High school diploma or equivalent required
• Bachelor's degree preferred.
• Oncology Experience preferred
• Minimum seven years of medical business office experience
• Two years experience managing, delegating, and following up on work priorities of others.
• Individual must have strong knowledge of medical insurance billing and collections with CPT, ICD9, and HCPC coding and medical terminology, as well as an overall understanding of managed care products (HMO, PPO, etc)
• Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint).

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

WORK ENVIRONMENT: The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.