The Revenue Cycle Manager is responsible for the direction and coordination of all revenue cycle operations, including both the ASC and outpatient clinic, from initial patient access to accurate adjudication of patient accounts. This scope of responsibility includes registration, charge capture, transcription, coding, billing and collections, self-pay collections, credentialing, cash management, revenue integrity, regulatory compliance, customer service, and general oversight of NWOS-wide accounts receivable. He/She maintains and facilitates the continual enhancement of effective and efficient operations of the revenue cycle functions throughout NWOS.
- Manages overall clinical revenue cycle for NWOS. Responsible for clinical revenue cycle activities in the practice and ASC sites, including registration, charge capture, transcription, coding, billing and collections, self-pay collections, credentialing, cash management, revenue integrity, regulatory compliance, and customer service. Front-end denials are aggressively managed and improvements are continually made to minimize/eliminate errors and unpaid claims.
- Develops detailed reports and models to monitor trends and identify early issues, including collection rates, outstanding A/R, denial trending, claim edit report, etc.
- Maintains knowledge of coding/reimbursement requirements for each Orthopaedic subspecialty within the Group. Stays abreast of current CPT/ICD guidelines as well as applicable payer coding policy changes, and educates billing team, physicians and other providers.
- Serves as EMR and PM system Super User. Demonstrates a leadership role in all aspects of EMR and PM system including issue identification, escalation and resolution.
- Continuously analyzes processes and workflow for improvement and automation opportunities.
- Responsible for all human resource management of billing, coding, credentialing, and transcription staff including hiring, training, performance evaluations, merit increases, promotions, and disciplinary actions of staff
- Develops policies and procedures to maximize the best use of technology through the EMR and PM system.
- In collaboration with the IT department, plans, directs, and coordinates information technology system upgrades and optimizations that enhance the revenue cycle process; provides revenue cycle expertise to complement the technical system implementation.
- Develops policies and procedures to ensure accurate registration and insurance information capture. Develops appropriate collection of point of service patient responsibility and monitors compliance. Manages pre-surgical case and pain management pricing process. Provides continuing education, reporting, and feedback to Office/ASC managers and staff.
- Develops work queues/suspension lists for staff to remediate issues prior to bill generation; monitor error rates, and educate staff to proactively correct errors.
- Participates as a member of the insurance contract negotiation team to ensure the appropriate codes and payment terms are incorporated into insurance contracts.
- All other duties assigned
Required Skills and Experience
- A minimum of five years medical billing experience, with a preference of some management experience. Physician practice with ambulatory surgery center (ASC) billing experience including anesthesiology is highly preferred.
- BS, BA or equivalent combination of education and experience required.
- Experience working with an electronic medical record and other information technology and systems that support financial integration across the organization is required.
- Strong physician relation skills, innovative solutions thinker, self starter.
Northwest Orthopaedic Specialists offers competitive compensation, great health benefits, 401(k), profit sharing, continuing education and many other useful supplemental benefits.