Manager, Revenue Cycle Management

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🕒 4 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

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Theoria Medical

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

⚕️ Seguro de Saúde

☁️ SaaS

📡 Telecomunicações

Healthcare Insurance • SaaS • Telecommunications

A Theoria Medical é líder em cuidados primários baseados em valor, habilitados por tecnologia, revolucionando a saúde para comunidades de idosos em todo o país. A empresa emprega um modelo de cuidado totalmente integrado, combinando serviços de cuidados primários com os mais recentes avanços tecnológicos para oferecer uma experiência de saúde holística e impactante para idosos. Suas ofertas inovadoras incluem monitoramento remoto de pacientes, diretoria médica, equipe médica no local, telemedicina e otimizações de fluxo de trabalho, todas ancoradas por tecnologias pioneiras como ChartEasy, ChatEasy e ProphEasy. A Theoria Medical está comprometida em melhorar os resultados dos pacientes por meio da inovação digital e atende pacientes em ambientes de enfermagem especializada, residências assistidas e independentes em todo os Estados Unidos.

Descrição

• Lead and manage the revenue cycle operations, including but not limited to billing, holds/credentialing, denials, collections, and accounts receivable management. • Assist in developing and implementing KPIs and policies and procedures to ensure accurate and timely submission of claims, reduce denials, and increase collections. • Analyze trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff, third party vendors and revise policies and procedures. • Identify and resolve revenue cycle issues, including coding and billing errors, incomplete or inaccurate patient information, insurance prioritization and other issues that may impact revenue. • Monitor and analyze revenue cycle metrics, including accounts receivable aging, claim submission, payment turnaround times, and denial rates. • Analyze billing and claims for accuracy and completeness; follow up with RCM teams and third party vendors on work queues, pending claims and unpaid AR. • Spearhead the resolution of rejected or underpaid claims by conducting targeted appeals and payer negotiations. • Analyze and manage overpayments from payers as well as implementing policies to reduce denials and refunds. • Work with credentialing, billing and coding staff to ensure compliance with regulatory requirements, including HIPAA and other federal and state regulations. • Develop and maintain strong relationships with RCM Directors, HR, Clinical Operations and Credentialing departments to ensure a smooth revenue cycle operation. • Review and respond to various payor correspondence • Communicate with patients and clients

🎯 Requisitos

• 7+ years of experience in revenue cycle management in a healthcare setting • Advanced knowledge of the healthcare industry and a strong financial background • Clear understanding of billing and collection regulatory guidelines and requirements • Vast CPT and ICD-10 expertise • Vast knowledge in credentialing and payor management • Proficient background in reimbursements • Experience in monitoring clearinghouse activity, reports, and processes • Experience in setting up payors with EDI, ERA, and EFT processes • Experience in managing and leading a team of revenue cycle professionals • Strong analytical skills and attention to detail • Ability to work in a fast-paced environment and manage multiple projects simultaneously • Agility, strong leadership, problem-solving skills • Ability to maintain up-to-date knowledge of technology and software including but not limited to Monday, Slack, Google suite of Applications, spreadsheets (Excel), Zoom, MS Teams, eClinicalWorks

🏖️ Benefícios

• Competitive Compensation • 401k with Employer Match • Health, Dental, and Vision Insurance • PTO and Holiday Pay • Employer Paid Life insurance Policy • Short and Long-Term Disability Insurance • Company Provided Equipment • Employee Assistance Program (EAP)