
Senior Revenue Cycle Operations Manager
5 days ago
Key Responsibilities:
- Ensure the efficient and effective functioning of revenue cycle processes within a healthcare organization.
- Oversee various aspects of revenue cycle operations, including patient registration, charge capture, coding, billing, claims processing, denial management, and accounts receivable follow-up.
- Optimize revenue generation, maximize collections, and minimize denials to ensure the financial health of the organization.
- Manage and supervise the revenue cycle operations, ensuring compliance with regulatory requirements and industry best practices.
- Develop and implement strategies to optimize revenue generation and enhance cash flow.
- Monitor key performance indicators (KPIs) and financial metrics to identify trends, areas for improvement, and potential revenue leakage.
- Collaborate with cross-functional teams, such as clinical departments, finance, coding, and compliance, to streamline revenue cycle processes.
- Oversee the timely and accurate submission of claims to third-party payers, including Medicare, Medicaid, commercial insurance companies, and self-pay patients.
- Monitor claim status and work closely with the billing team to resolve any coding or billing discrepancies.
- Analyze denial patterns, identify root causes, and implement corrective measures to minimize denials and maximize collections.
- Stay updated with changes in healthcare regulations, payer policies, and coding guidelines to ensure compliance and accurate billing.
- Review and analyze accounts receivable aging reports to identify delinquent accounts and take appropriate actions for timely payment.
- Implement strategies for effective accounts receivable follow-up, including phone calls, appeals, and negotiations with payers and patients.
- Collaborate with the finance team to reconcile payments, identify posting errors, and resolve outstanding balances.
- Provide guidance and support to the team in resolving complex billing and reimbursement issues.
- Continuously assess revenue cycle processes, identify inefficiencies, and recommend process improvements to enhance operational efficiency and revenue integrity.
- Implement automation and technology solutions to streamline workflows and reduce manual intervention.
- Conduct regular audits and reviews to ensure compliance with coding guidelines, billing regulations, and internal policies.
- Develop and deliver training programs to educate staff on revenue cycle best practices, coding updates, and compliance requirements.
- Bachelor's degree in Healthcare Administration, Business Administration, or a related field (master's degree preferred).
- Experience in revenue cycle management or healthcare finance.
- Strong knowledge of healthcare reimbursement systems, billing regulations, and coding guidelines (e.g., CPT, ICD-10, HCPCS).
- Proficiency in using revenue cycle management software and electronic health record (EHR) systems.
- Familiarity with third-party payer requirements, including Medicare, Medicaid, and commercial insurance.
- Excellent analytical and problem-solving skills with the ability to interpret financial data and identify trends.
- Strong leadership and team management abilities.
- Effective communication and interpersonal skills to collaborate with various stakeholders.
- Certified Professional Biller (CPB) or Certified Revenue Cycle Specialist (CRCS) certification is a plus.
- Ability to stay updated with changes in healthcare regulations, payer policies, and coding guidelines.
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