Summary
The Manager of Revenue Cycle oversees data analysis, follow-ups, and implements recommendations. They ensure accurate coding and billing of medical claims (including CalAIM & Drug Medi-Cal billing), review patient records, and guide billing practices in accordance with all applicable coding and billing guidelines. Reporting to the Clinic Director, they collaborate with other departments and directly supervise the Revenue Cycle Analyst.
Essential Functions
- Supports Cal AIM and Drug Medi-Cal claims in addition to supervising Health Center Revenue Cycle.
- Directly supervises Revenue Cycle Analyst
- Monitor and analyze coding and billing data to identify trends and opportunities for improvement.
- Advanced organizational and project management skills, and ability to lead a team, prioritize tasks, and see projects through from inception to completion on schedule
- Collaborate with other departments, such as clinicians and third-party claims processing, to identify and address coding, payment, and billing issues.
- Monitor and analyze key performance indicators (KPIs) related to revenue cycle performance.
- Develop and implement policies and procedures to improve revenue cycle efficiency and compliance.
- Ensure accurate and timely documentation of coding and billing activities in health plan systems to adhere to company policy.
- Assists, supports, and trains other departments on health insurance packages for clean claim processing.
- Participate in internal and external audits and reports.
- Stay updated on healthcare regulations and reimbursement changes, ensuring compliance with all federal and state laws.
- Prepare and present financial reports to senior management, identifying trends and areas for improvement.
- Assign and provide guidance on appropriate codes to health plan claims in compliance with regulatory requirements and health plan policies.
- 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 submitting applications for new contract agreements.
- On-time completion of assigned training and policies
- Performs other duties as assigned
Qualifications
- Bachelor’s degree in healthcare administration, finance, business administration, or a related field (Master's degree preferred).
- Certified Professional Coder (CPC) – AAPC, preferred.
- 6+ years experience in revenue cycle management in a healthcare setting.
- 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.
90000.00 To 113400.00 (USD) Annually
