Senior RCM Manager

Company Description

Gentell is a leading global provider of innovative, efficient, and affordable wound care solutions tailored to meet the individualized needs of patients in nursing homes, hospices, and hospitals. With clinical specialists across the United States and Canada, we offer expert recommendations and education to support proper use of wound care products. As one of North America's largest manufacturers of wound care supplies, Gentell operates production facilities in the United States, Canada, and China. Our comprehensive product line includes advanced and traditional wound care dressings and skin protection products, ensuring optimal patient care and outcomes.

Role and Responsibilities:

• Responsible for managing a team of Medical Billers, Credentialing and Medical Coders in physician billing process
• Responsible for managing client and provider escalations. Account management responsibilities.
• Responsible for direct physician, provider, and US team interaction
• Responsible for process improvement, process optimization, ageing reports, analytics, and SLA management.
• Responsible for all internal quality audits and ensuring maximum team performance and output with no delays and errors.
• Responsible for developing and managing team through specific well defined KRA/KPI, work timings, attendance, and performance management.
• Responsible for training and development of existing team members and ensuring the overall quality improvement.
• Prepare, analyze, and present regular MIS reports for management review on various business metrics like Team performance, SLA, Quality checks, SLA etc.
• Take the lead in interaction with all US based team members/clients/physicians/providers.
• Identifying scenarios with global issue for the entire patient account or multiple patient accounts impacted with same scenario.
• Will be required to play an individual contributor hands-on role ~50% of the time in various RCM areas as per business requirement.
• Develops and maintain standard operating procedures for assigned areas of responsibilities.
• Deliver RCM and coding expertise against defined Product initiatives.
• Monitors aged accounts and verifies appropriate collections procedures are being followed.
• Monitor and evaluate team effectiveness and individual productivity measured against established performance standard .
• Produce monthly statistical reports for management on billing-related task.
• Analyzes and interprets data to initiate and facilitate implementation of solutions for process, quality and procedural improvements within the Enterprise Revenue Cycle by understanding Enterprise Revenue Cycle operations, processes, systems, regulations, clinical practice, payer changes and data

Desired Candidate Profile

• Bachelors Degree
• Must have at least 5 years' experience in US healthcare RCM team management.
• Minimum of 3 years of experience transforming revenue cycle processes to maximize realizable revenue, minimize denials and accelerate cash flow.
• Ability to manage multiple initiatives, identify and prioritize issues to meet aggressive deadlines and organizational goals
• Must be familiar with all aspects of RCM including but not limited to Patients Collections, AR Follow Up, Insurance Processing, Payment Posting, Customer Service, Eligibility Verification, HIPPA compliance, Credentialing, Physician onboarding, Medical Coding, Administrative Duties etc.
• CPT and ICD9 coding experience including use of modifiers and HCPCS codes. Understand CMS-1500 and UB-04 claim formats.
• Understanding of all RCM terminology. Basic knowledge of collection laws, rules, and regulations. HIPPA certification or CPC certification will be big plus.
• Knowledge of medical billing software, preferably BrightTree, Kareo, Therapy Notes, Simple Practice, Theranest or any other similar.
• Experience reading and interpreting and entering insurance EOBs.
• Excellent supervisory, problem solving and decision making skills required
• Proficient in Microsoft 365 office applications like Teams, Outlook, CRM Dynamics, OneDrive etc.
• Soft skills required:
• Excellent verbal and written English communication skills for interacting with USA based team members/ physicians/ vendors/patients.
• Willing to work in USA PDT/EDT timings and/or any other flexi shift timings based on business requirements.
• Professional and able to make a great impression on the phone. Required to understand, communicate & work regularly with USA based team.
• Excellent business communication skills and phone/email etiquettes.
• Positive attitude and able to provide required guidance to team members.
• Willing to cross train and cross learn other areas of RCM.
• Tact, diplomacy, and the ability to maintain confidentiality of company, client, and patient information.
• Must have very strong work ethic and an excellent attention to detail.
• Able to work under deadlines & target pressure and handles rejection well.