Manager, Revenue Cycle

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time offand 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do:

* Manages the verification, validation, and prioritization of payer setup for patients, clients, and members. Ensures payers are set up accurately to maximize reimbursement and minimize unbilled services. Implements processes to reduce verification-related delays.

* Manages processes to request, obtain, and enter managed care authorizations for patients. Implements initiatives to minimize authorization-related delays in patient care while maximizing collections.

* Oversees and manages Accounts Receivable processes, including billing, collections, adjustments, Med Max, Medicare remittance processing, premium billing, reconciliation, and related activities.

* Assists in the development and implementation of standards, policies, and procedures related to staff, operations, and third-party payers. Develops and maintains effective relationships with third-party payers and governmental agencies to resolve issues related to claims processing and reimbursement.

* Participates in the design, implementation, and enhancement of workflows and policies to maximize operational efficiency. Serves as a technical resource and educates staff on billing practices to maximize reimbursement and benefits.

* Participates in the development of departmental short- and long-term objectives aligned with overall organizational goals.

* Oversees and coordinates the work of third-party vendors, including outsourced functions and vendor-augmented staff.

* Identifies issues involving governmental and third-party payers and collaborates with Managed Care Contracting, internal departments, and payers to resolve matters related to eligibility, authorizations, timely collections, and claims processing. Assists in reviewing and approving changes to managed care payers and rates within the payer table.

* Evaluates and implements billing and reimbursement procedures issued by third-party payers and governmental agencies. Ensures appropriate follow-up with the Human Resources Administration (HRA) to expedite outstanding Medicaid-pending cases, support patient satisfaction goals, and facilitate timely Medicaid billing.

* Works closely with operations and other departments to coordinate activities affecting departmental policies and procedures. Follows up to obtain required clinical documentation and coordinate eligibility for billing and payment, as needed. Monitors and analyzes Accounts Receivable and unbillable reports to identify trends, address issues, and maximize revenue. Maintains a working knowledge of VNS Health operations and services.

* Collaborates with departmental leadership to identify solutions to common operational challenges and standardize processes, as appropriate. Assists in the design and implementation of revenue cycle workshops to support staff training and development. Monitors and tracks staff productivity to ensure departmental performance targets are achieved.

* Manages and implements financial evaluation and Medicaid eligibility procedures to ensure the timely filing and completion of new Medicaid applications and recertifications. Establishes procedures for pooled income trusts and the Surplus Project to reduce Medicaid-pending cases, charity care, and unbillable visits.

* Develops and monitors key performance indicators for the Cash Applications group.

* Assists in the development, testing, and implementation of IT and organizational initiatives related to verification, authorization, billing, collections, premium billing, spenddown, and reconciliation.

* Performs all duties inherent in a managerial role, including ensuring effective staff training, evaluating employee performance, providing input into departmental budget development, and making recommendations regarding hiring, promotions, terminations, and salary actions, as appropriate.

* Plans and analyzes Revenue Cycle IT projects and manages all aspects of project execution to ensure successful delivery in accordance with internal and external customer expectations.

* Collaborates with external vendors, Revenue Cycle teams, and Information Technology staff during system updates, upgrades, and enhancements. Supports the analysis, testing, and implementation of Revenue Cycle IT projects and resolution of billing-related system issues. Provides IT project management support as needed.

* Maintains compliance with HIPAA requirements and organizational standards related to business continuity, disaster recovery, and emergency response.

* Participates in special projects and performs other duties as assigned.

Education:
Associate's Degree in Business Administration, Accounting, a related field, or the equivalent (or equivalent work experience) requiredBachelor's Degree in Business Administration, Accounting, a related field, or the equivalent (or equivalent work experience) preferred

Work Experience:

* Minimum of five (5) years of progressive experience in Accounts Receivable administration, preferably within a healthcare organization, required.

* Minimum of two (2) years of supervisory experience, required.

* Proficiency with Microsoft Office Suite, including Microsoft Word and Excel, required.

* Strong knowledge of third-party payer billing and reimbursement requirements, required.

* Excellent oral and written communication, analytical, and problem-solving skills, required.

* Knowledge of manual and/or automated office systems, including process design and implementation, required.

* Experience managing Information Technology projects with a demonstrated track record of successful project delivery, preferred.

* Knowledge of project management methodologies, processes, and tools, preferred.