Manager, Revenue Cycle Operations

Job Summary: The Manager of Revenue Cycle Operations is responsible for overseeing and managing all aspects of the revenue cycle process to maximize efficiency and revenue for the healthcare organization. This role involves coordinating various functions, including billing, coding, claims processing, collections, and payment posting, to ensure the financial health of the organization. The Manager will also develop and implement strategies to improve revenue cycle performance, enhance patient satisfaction, and ensure compliance with regulations.

Key Responsibilities: Leadership: Provide leadership and direction to the revenue cycle team, including billing, coding, claims, collections, and payment posting staff. Recruit, train, and develop team members to ensure high performance and professional growth. Conduct regular performance evaluations and provide feedback and coaching to team members.

Revenue Cycle Optimization: Develop and implement strategies to improve revenue cycle processes and increase efficiency. Monitor key performance indicators (KPIs) and develop action plans to address areas of improvement. Utilize data analytics to identify trends, issues, and opportunities for revenue enhancement.

Billing and Coding: Oversee the billing and coding processes to ensure accurate and timely submission of claims. Ensure compliance with coding guidelines, payer requirements, and regulatory standards. Collaborate with clinical departments to resolve coding and documentation issues.

Claims Management: Manage the claims submission process, including electronic and paper claims. Monitor claim denials and rejections and develop strategies to reduce denial rates. Work with payers to resolve claim issues and ensure timely reimbursement.

Collections and Payment Posting: Oversee the collections process to ensure timely and accurate patient payments. Develop and implement policies and procedures for payment posting and reconciliation. Manage patient accounts and resolve billing inquiries and disputes.

Compliance and Regulations: Ensure compliance with federal, state, and local regulations, including HIPAA and other healthcare laws. Stay updated on changes in healthcare regulations and payer requirements. Implement and enforce policies and procedures to maintain compliance.

Reporting and Analytics: Prepare and present regular reports on revenue cycle performance to senior management. Utilize data analytics to identify trends, issues, and opportunities for improvement. Develop and implement dashboards and other tools to monitor revenue cycle metrics.

All Other Duties as Assigned Qualifications: Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or related field. Master’s degree preferred. Minimum of 5 years of experience in revenue cycle management, with at least 2 years in a supervisory or managerial role.

Strong knowledge of healthcare billing, coding, claims processing, and collections. Familiarity with healthcare regulations, including HIPAA and payer requirements. Proficiency in revenue cycle management software and electronic health record (EHR) systems.

Excellent leadership, communication, and interpersonal skills. Strong analytical and problem-solving abilities. Ability to work in a fast-paced and dynamic environment.