Manager, Revenue Cycle Management

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🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

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Theoria Medical

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

☁️ SaaS

📡 Telecommunications

Healthcare Insurance • SaaS • Telecommunications

Theoria Medical is a leader in tech-enabled, value-based primary care, revolutionizing healthcare for senior living communities nationwide. The company employs a fully integrated model of care, combining primary care services with the latest technological advancements to offer a holistic and impactful healthcare experience for seniors. Their innovative offerings include remote patient monitoring, medical directorship, on-site medical staff, telemedicine, and workflow optimizations, all anchored by pioneering technologies like ChartEasy, ChatEasy, and ProphEasy. Theoria Medical is committed to enhancing patient outcomes through digital innovation and serves patients in skilled nursing, assisted living, and independent living settings across the United States.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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)