Summary:
The Supervisor of Revenue Cycle oversees the analysis of data, performing follow-ups as needed and implementing recommendations. Ensures teams quality and provides recommendations and analysis to leadership. Is responsible for overseeing the accurate coding and billing of medical claims in accordance with all applicable coding and billing guidelines. This includes reviewing patient medical records, assigning appropriate diagnosis and procedure codes, and providing guidance on appropriate billing practices.
The ideal candidate will have a strong understanding of medical terminology, coding guidelines, payer contracts, and insurance billing procedures. This position will report to the Manager of Administrative Services and work closely with other entities and departments to support and reach projected goals. This position oversees the Revenue Cycle Analyst.
Essential Functions:
- Monitor and analyze coding and billing data to identify trends and opportunities for improvement.
- Collaborate with other departments, such as clinicians and third-party claims processing, to identify and address coding, payment, and billing issues.
- Ensure accurate and timely documentation of coding and billing activities in health plan systems to adhere to company policy.
- Generate revenue cycle reports to monitor and analyze data to identify trends, opportunities, and areas for improvement.
- Assists, supports, and trains other departments on health insurance packages for clean claim processing.
- Participate in internal and external audits of coding and billing processes.
- Monitoring of billing work queues to assure issues are addressed and claims are submitted within policy guidelines.
- Provide guidance regarding billing and claims practices to internal departments.
- Review medical records to ensure accurate coding of diagnoses and procedures.
- Assign and provide guidance on appropriate codes to health plan claims in compliance with regulatory requirements and health plan policies.
- Responds to patient, insurance, and medical record billing inquiries.
- Provide education and training to staff on coding and billing requirements and best practices.
- Attends and participates in internal department meetings and external peer network groups.
- Maintain knowledge of current coding and billing regulations and guidelines.
- Responsible for oversight of "Annual Payors Contract Agreement Renewals" timely submission.
- Responsible for oversight of submitting applications for new contract agreements.
- On-time completion of assigned training and policies
- Oversees Revenue Cycle Analyst
- Performs other duties as assigned
Qualifications:
- Associate degree, bachelor's degree, or equivalent relevant work experience
- Certified Professional Coder (CPC) - AAPC
- 5+ Years experience working as a certified coder.
- 5+ years working in a healthcare setting including an Electronic Health Record system
- 3+ years in leadership, overseeing direct reports
- Strong understanding of medical terminology, coding guidelines, and insurance billing procedures.
- Applies understanding of Medicare, Medi-Cal and other payor guidelines.
- Familiarity with Cal-Aim billing and Drug Medi-Cal programs preferred.
- Knowledge of medical terminology, including but not limited to, ICD10; CPT; HCPC; CDT; and PPS.
- Strong communication, analytical, and problem-solving skills.
- Team-oriented and self-motivated with a positive attitude.
- Proficiency in Microsoft Office applications
- Excellent written and verbal communication skills.
- Strong organizational and time management skills.
- Knowledge of and compliance with HIPAA privacy laws
- Working knowledge of healthcare EPIC software preferred.
77400.00 To 84600.00 (USD) Annually
