Revenue Cycle Manager
Much has changed since that time. Today the Sycuan Tribe governs its Reservation, owns and operates a Casino and a Golf Resort, and owns a number of other business ventures in the San Diego Region.
One attribute that remains unchanged, however, is Sycuan's sense of community. Sycuan is more than just a business. Sycuan is a community of people working together toward a common goal. Whether you work in our state-of-the-art Casino, our beautiful Resort, or become a staff member in our Tribal Government division, you will be part of the Sycuan family.
The Revenue Cycle Manager manages all functions of the organization’s billing and revenue cycle to maximize cash flow while maintaining and improving internal and external customer relations. The manager with foster a positive and engaging work environment, provide exceptional service to others while operating as effectively and efficiently as possible and in compliance with all applicable laws and regulations.
Scope of Practice:
- Manages Revenue Cycle team operations including all aspects of the revenue cycle process including: insurance verification, coding, charge-entry, claims submission, collections and payment posting.
- Serves as the resident expert and "go to" person for all verification, coding, billing and collections processes.
- Develops, reviews and enhances operating policies and procedures to improve quality and efficiency.
- Analyzes actionable claims data, including revenue and volume, by region, payer, plan, clinic, provider, procedure code, etc.
- Ensures compliance with coding and billing regulations, relevant healthcare regulations and data privacy issues (e.g., HIPAA).
- Coordinates team member paid time off (PTO) in a manner that does not negatively impact necessary daily functions.
- Prepares and reviews periodic reports of performance metrics with the Administrative Director, and appropriate department leaders and teams.
- Provides analysis, creates written processes and trains others in implementing a cross functional revenue cycle team.
- Performs other miscellaneous job-related duties as assigned.
- Supervise and evaluate assigned support staff in a timely manner. This position will supervise biller/coders, FSRs and PSRs.
- Ensure accuracy of deposits, demographic and other information entered into the patient billing system
- Participate in program/service evaluation activities; facilitate changes in provision of service based on Continuous Quality Improvement results.
- Compile and prepare various status reports for management in order to analyze trends and make recommendations.
- Participate in preparation of annual UDS report.
- Monitor data integrity for the practice management system. Report problems to the Administrative Director or other appropriate personnel in a timely manner.
- Provide a monthly summary on the status of outstanding charges of the Accounts Receivable Aging report for all balances over $100.
- Provide monthly report on the status of credit balances. (Unapplied Credit Analysis Report)
- Monitor gross charges to determine the potential need for an update to the fee schedule on at least an annual basis. Report findings and recommendations to ADMINISTRATIVE DIRECTOR by October each year.
- Coordinate with the Department Leaders to stay current on credentialing issues, especially in the case of new providers, with an emphasis on scheduling mainly self-pay patients for the new providers until they are credentialed with third party organizations.
- Monitor volume of charge and collection posting on a monthly basis to confirm that Billing team members are keeping up with patient encounter volume. Recommend and/or implement changes to work schedule, as needed, when work flow in the Billing Department is significantly behind.
- Responsible for ensuring the timeliness of processing and correction of rejected claims.
- Maintain rosters of Managed Care patients for all plans which have been active within the two most recent calendar years.
- Maintain regular schedule for sending out billing statements in accordance with the Financial Policies and Procedures.
- . Maintain and process for review of all billing statements which are returned to sender. Utilize public records and other resources to make best effort to obtain accurate billing addresses.
- Maintain a regular schedule for writing off bad debts, including a process which requires and documents attempts to collect or resubmit prior to removing the charge from outstanding receivables. Submit Bad Debt Write Off Report to Administrative Director.
- Monitor coding practices among providers to determine potential patterns of under coding or other irregularities.
- Keep Billing team up to date on third party coverage contracts, assuring that current contractual terms are understood and applied correctly.
- Establish and maintain a regular process for follow up on patient accounts which are pending approval for third party coverage.
- Maintain current information for billing and collections processes for each third party carrier in a Billing Manual.
- Work with Department Leaders and Schedulers to assure that patients are informed of requirements such as income and/or insurance verification at the time that the appointment is scheduled. Confirm that patients who have coverage that is not accepted at our organization are made aware of this fact before appointment is scheduled.
- Assure that the need for any referrals and/or authorizations are addressed at the time of scheduling the appointment.
- Train Front Office Assistants to identify uninsured patients who may qualify for Medicaid or other programs which can cover some or all charges.
- Maintain process for verifying insurance at the time of each billable patient encounter.
- Monitor and identify any patterns in remittance advices which would indicate the Front Office Assistants are not properly collecting insurance information. In coordination with Administrative Director, initiate retraining and/or other corrective action indicated.
- Maintain a process of coverage verification for scheduled patients prior to appointment.
- Coordinate the Revenue Cycle Management team to address any deficiencies in staff performance uncovered by internal audits.
- Must hold all patient Protected Health Information (PHI) and other patient personal information and agency information in confidence, in accordance with the Employee Confidentiality Statement, which you have read, understand and signed.
- Actively participates in and complies with all aspects of the NHFHS Corporate Compliance Program, follow the Program Code of Conduct and obey all relevant laws, statutes, regulations and requirements applicable to Medicaid, Medicare and other State and Federal health care programs.
- Participate in SMDC Quality Program, other internal committees, special projects/observances or activities that promote improvements in organizational performance and/or advance the mission, goals and objectives of Family Health Centers.
- Adhere to schedules for work, lunch and breaks.
- Bachelor’s Degree in Business, Healthcare Administration or equivalent and/or minimum of five (5) years of medical billing experience
- Minimum of three years in a supervisory role
- Knowledge of professional fee billing, reimbursement and third party payer regulation and medical terminology is required
- Working knowledge of regulatory requirements pertaining to health care operations and their impact on operations
- Current CPR certification
- Experience with the physician credentialing process
- Tribal Clinic experience
- Tribal enterprise experience
- Medical (NextGen), Dental (Dentrix), Behavioral Health (NextGen) and Pharmacy (QS30) EMR experience
Knowledge, Skills, and Abilities:
- Strong problem-solving skills and ability to make timely decisions
- Strong attention to detail
- Demonstrated coding and billing knowledge/experience preferred
- Excellent English oral and written communication skills
- Excellent knowledge of outpatient billing protocols
- Ability to create, and complete forms and documents
- Ability to prioritize and perform multiple tasks
- Ability to maintain confidentiality
- Ability to appear for work at scheduled time
- Ability to maintain professionalism and composure
- Ability to accept constructive criticism
- Excellent knowledge of laws and regulations governing medical records and medical office management
- Ability to provide excellent internal and external customer service
Physical and Mental Requirements:
- Able to sit for long period of time, move from place to place, and stand for periods of time
- Ability to do math, organize and prioritize workload, work effectively and efficiently under stress
- Ability to supervise, multitask, understand and follow instructions
- Ability to proficiently read, write, speak and understand English
- Ensure compliance with policies and procedures related to safe work practices
- Uses all appropriate equipment and/or tools to ensure workplace safety
- Immediately reports unsafe working conditions
- Follow all infection control procedures including blood-borne pathogen protocol
- Be familiar with and know locations of Safety Data Sheet Binder
- Maintains privacy and security of all patient, employee, and volunteer information and access to such information. Such information is accessed on a need to know basis for business purposes only.
- Complies with all regulations regarding corporate integrity and security obligations. Reports unethical, fraudulent or unlawful behavior or activity.
- Upholds strict ethical standards.
- Pay Type Salary
- Tribal, 2 Kwaaypaay Court, El Cajon, California, United States of America