Albany Area Primary Health Care (AAPHC)
Revenue Cycle Manager (In office required)
Albany Area Primary Health Care (AAPHC), Albany, Georgia, United States, 31701
Overview
Revenue Cycle Manager (In office required) – Albany GA (Albany Area Primary Health Care, AAPHC). Job Summary: Utilizing expertise in Revenue Cycle Management and leading strategic revenue management initiatives to achieve outcomes related to improved patient, physician, and payer experiences. Provides leadership and recommendations to the Revenue Cycle team including registration, charge-entry, pricing, payer-provider enrollment, compliance, coding and service documentation, and all other aspects of front-end claims processing functions. Job Classification:
219 FLSA:
Exempt Reports to:
CFO Location:
Albany, GA (In Office)
Responsibilities
Revenue Cycle Oversight by managing front-end and back-end revenue cycle operations including registration, coding, billing, collections, and documentation Lead operation assessment, development and implementation of operation systems and procedures to improve process cycle times and assure timely billing and collection of fees for services rendered Develop and monitor compliance with policies and procedures for revenue cycle management Build productive relationships with staff, insurance providers and other vendors Contract Negotiation Support including collaborating with payors and providers to negotiate and maintain contracts aligned with organizational goals Assess and establish performance benchmarks. Communicate to teams on the performance standard and quality expectation to help achieve or exceed performance goals Monitor KPIs to work with individuals to improve service levels, cash flow, reduce denials, and minimize delinquent debt Provide strategic direction of claims processing and revenue assurance Manage staff and provide training, ongoing education, and coaching/mentoring for department members Continuously evaluate department efficiency, design and implement improvement strategies to ensure revenue optimization Payor Analytics & Contract Modeling - Analyze contracted and government payor rates to support reimbursement modeling Develop models for fee-for-service, prospective payment system, risk-based, bundled payment, and value-based contracts Ensure payments align with contracted fee schedules and address underpayments or denials Oversight of credentialing and enrollment Create strategic and related tactical plan to ensure reimbursement and billing services are extraordinary Identify specific billing and reimbursement projects as they arise, allocate resources, track progress and take corrective action as required Direct and oversee plans to ensure SOPs are in place for benefits investigations, appeals and billing operations and ensure SOPs are followed; provide direction and remediation recommendations Identify problems, offer solutions, and participate in resolution
Education & Training
Bachelor’s Degree required. Bachelor’s/master’s degree preferably in healthcare administration In-depth knowledge of healthcare business practices, compliance, billing and collection operations (both insurance and institution), ICD-10 coding, CPT, analytics, third party clearing houses and analytics, practice management software, and AR management
Experience & Skills
Minimum 5 years of experience in Revenue Cycle Management Minimum 3 years in a managerial role in RCM FQHC or community health center experience strongly preferred Experience with federal healthcare programs and compliance requirements Ability to multi-task, prioritize and work independently in a fast-paced, high-volume environment Ability to communicate and work effectively with the leadership team, staff, physicians, and external customers Strong leadership skills and sense of responsibility
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Medical Practices
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Revenue Cycle Manager (In office required) – Albany GA (Albany Area Primary Health Care, AAPHC). Job Summary: Utilizing expertise in Revenue Cycle Management and leading strategic revenue management initiatives to achieve outcomes related to improved patient, physician, and payer experiences. Provides leadership and recommendations to the Revenue Cycle team including registration, charge-entry, pricing, payer-provider enrollment, compliance, coding and service documentation, and all other aspects of front-end claims processing functions. Job Classification:
219 FLSA:
Exempt Reports to:
CFO Location:
Albany, GA (In Office)
Responsibilities
Revenue Cycle Oversight by managing front-end and back-end revenue cycle operations including registration, coding, billing, collections, and documentation Lead operation assessment, development and implementation of operation systems and procedures to improve process cycle times and assure timely billing and collection of fees for services rendered Develop and monitor compliance with policies and procedures for revenue cycle management Build productive relationships with staff, insurance providers and other vendors Contract Negotiation Support including collaborating with payors and providers to negotiate and maintain contracts aligned with organizational goals Assess and establish performance benchmarks. Communicate to teams on the performance standard and quality expectation to help achieve or exceed performance goals Monitor KPIs to work with individuals to improve service levels, cash flow, reduce denials, and minimize delinquent debt Provide strategic direction of claims processing and revenue assurance Manage staff and provide training, ongoing education, and coaching/mentoring for department members Continuously evaluate department efficiency, design and implement improvement strategies to ensure revenue optimization Payor Analytics & Contract Modeling - Analyze contracted and government payor rates to support reimbursement modeling Develop models for fee-for-service, prospective payment system, risk-based, bundled payment, and value-based contracts Ensure payments align with contracted fee schedules and address underpayments or denials Oversight of credentialing and enrollment Create strategic and related tactical plan to ensure reimbursement and billing services are extraordinary Identify specific billing and reimbursement projects as they arise, allocate resources, track progress and take corrective action as required Direct and oversee plans to ensure SOPs are in place for benefits investigations, appeals and billing operations and ensure SOPs are followed; provide direction and remediation recommendations Identify problems, offer solutions, and participate in resolution
Education & Training
Bachelor’s Degree required. Bachelor’s/master’s degree preferably in healthcare administration In-depth knowledge of healthcare business practices, compliance, billing and collection operations (both insurance and institution), ICD-10 coding, CPT, analytics, third party clearing houses and analytics, practice management software, and AR management
Experience & Skills
Minimum 5 years of experience in Revenue Cycle Management Minimum 3 years in a managerial role in RCM FQHC or community health center experience strongly preferred Experience with federal healthcare programs and compliance requirements Ability to multi-task, prioritize and work independently in a fast-paced, high-volume environment Ability to communicate and work effectively with the leadership team, staff, physicians, and external customers Strong leadership skills and sense of responsibility
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Medical Practices
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