The Revenue Cycle Manager is responsible for overseeing the entire revenue cycle process within a healthcare organization. This includes managing billing, coding, collections, and financial reporting to ensure optimal revenue flow, compliance, and efficiency. The role requires close collaboration with clinical and administrative staff to streamline processes and resolve any issues related to patient accounts and billing.

Key Responsibilities:

• Revenue Cycle Oversight:
  • Manage and supervise the end-to-end revenue cycle process, including patient registration, charge capture, coding, billing, collections, and accounts receivable.
  • Ensure timely and accurate submission of claims to payers, and follow up on unpaid or denied claims.
• Process Improvement:
  • Analyze revenue cycle performance metrics and identify areas for improvement.
  • Implement best practices and process improvements to enhance revenue cycle efficiency and accuracy.
  • Develop and monitor key performance indicators (KPIs) related to revenue cycle management.
• Billing and Coding:
  • Oversee billing and coding processes to ensure compliance with current coding guidelines and regulations (e.g., ICD-10, CPT).
  • Address coding errors and discrepancies and work with coding staff to resolve issues.
• Financial Reporting:
  • Prepare and present financial reports related to revenue cycle performance, including revenue, collections, and outstanding accounts receivable.
  • Monitor and analyze financial data to identify trends and provide actionable insights.
• Compliance and Regulations:
  • Ensure adherence to healthcare regulations and payer requirements, including those related to billing, coding, and documentation.
  • Stay current on changes in healthcare laws, regulations, and reimbursement policies.
• Team Management:
  • Supervise and train revenue cycle staff, including billing specialists, coders, and collections agents.
  • Conduct regular performance reviews, provide coaching, and ensure staff development.
• Patient and Payer Relations:
  • Address and resolve patient billing inquiries and disputes in a timely manner.
  • Build and maintain positive relationships with payers and other external stakeholders.
• Technology and Systems:
  • Oversee the implementation and use of revenue cycle management software and tools.
  • Collaborate with IT and other departments to ensure that systems are functioning effectively and efficiently.
• Audit and Compliance:
  • Conduct regular audits of revenue cycle processes to ensure compliance and identify areas for improvement.
  • Prepare for and manage external audits and reviews related to revenue cycle management.

Qualifications:

• Education: Bachelor’s degree in Healthcare Administration, Finance, Business Administration, or a related field. Certification in Revenue Cycle Management (e.g., Certified Revenue Cycle Professional (CRCP)) is preferred.
• Experience: Proven experience in revenue cycle management within a healthcare setting, with a strong understanding of billing, coding, and compliance.
• Skills:
  • In-depth knowledge of healthcare billing, coding, and reimbursement processes.
  • Strong analytical and problem-solving skills.
  • Proficiency in revenue cycle management software and electronic health records (EHR) systems.
  • Excellent communication and interpersonal skills for working with patients, payers, and staff.
  • Ability to manage and lead a team effectively.