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Manager, Revenue Cycle @ Pacific Cardiovascular Associated Medical Group, Inc. (PCA)

Current Employee? Job ID 17000T6G

PURPOSE AND SCOPE:

The Manager, Revenue Cycle provides direction and oversight of all ongoing revenue cycle activities within the assigned function(s) to ensure the timely and accurate collection of accounts receivable balances.  The incumbent develops and implements policies and procedures to ensure operations are in compliance with all applicable local, state, federal and regulatory requirements within the assigned function(s).

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Manage the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, methods, and staffing.
  • Management/implementation of all business-related functions from point of entry to accurate adjudication of the patients’ accounts. Specific areas of responsibility include revenue cycle training, credentialing, registration, claims management, billing, collections, patient insurance, data processing, integrity of patient accounts, accounts receivable management, practice management system file maintenance, and third-party revenue cycle vendors.
  • Monitors aged accounts and verifies appropriate collections procedures are being followed. Manages revenue cycle projects at the practice level, such as audits and budgets.
  • Resolves escalated reimbursement issues with payers and practices for optimal management of accounts receivable. Challenges the status quo and champions new initiatives; acts as a catalyst of change and stimulates others to change; paves the way for needed changes; manages implementation effectively. Steps forward to address difficult issues and takes ownership.
  • Responsible for the overall coordination of front office duties to include scheduling, check-in, and co- pay/co-insurance collection.
  • Oversee the ongoing accounts receivable activities within the assigned function(s) to effectively maintain positive cash flow and maximize reimbursement while minimizing bad debt in compliance with company policies procedures, applicable state, federal and regulatory requirements.
  • Review policies and procedures with a focus on continuous improvement efforts; developing and implementing policies and procedures to maximize the efficacy and efficiency of operations within the assigned function(s).
  • Facilitate closes processes within the assigned function(s) on a routine basis; ensuring data accuracy and integrity in compliance with company reporting requirements.
  • May drive electronic data interchange (EDI) initiatives to ensure the utilization of all available billing options.
  • May monitor accounts receivable performance and trends; addressing any issues that may have a negative impact on the efficacy and efficiency of operations of the assigned function(s).
  • May prepare required reports for management review on a routine or ad hoc basis.
  • Serve as a subject matter expert (SME) by maintaining current knowledge of local, state and federal regulations in compliance with Medicaid and Medicare requirements as they affect the assigned function(s).
  • Establish and maintain strong working relationships with cross-divisional teams, management, vendors and/or consultants to ensure the effective resolution of any issue within the assigned function(s).
  • Provide leadership, coaching and development plans for all direct reports to maintain an engaged and productive workforce; partnering with Human Resources on employee matters.
  • Provide technical guidance.
  • Assist with various projects as assigned.
  • Additional responsibilities may include focus on one or more departments or locations.  See applicable addendum for department or location specific functions.



PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Travel may be required.

SUPERVISION:

May be responsible for the direct supervision of various levels of billing, collections, reimbursement and/or revenue cycle staff.

EDUCATION:

Bachelor’s Degree required; Advanced Degree desirable

EXPERIENCE AND REQUIRED SKILLS:

  • 6 – 8 years’ related experience.
  • 3+ years’ supervisory or project/program management experience preferred.
  • Advanced knowledge of medical billing CPT, ICD10 and HCPCS coding and medical terminology.
  • Experience with Nextgen preferred
  • Thorough knowledge and understanding of MACRA and MIPS.
  • Overall understanding of managed care products (HMO, PPO, etc.)
  • Strong working knowledge of general accounting and revenue cycle.
  • Strong computer skills with demonstrated proficiency in word processing, spreadsheet, database and email applications.
  • Detail oriented with strong analytical and organizational skills.
  • Strong time management skills with the ability to multitask concurrent priorities in an organized manner.
  • Proactive management style to effectively lead cohesive and productive teams.
  • Must be able to coach others and further develop their knowledge and skills; prior training experience preferred.
  • Excellent oral and written communication skills to effectively communicate with all levels of management.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Current Employee?