As a Senior Associate in Revenue Cycle Management, you will be responsible for ensuring the efficient and effective functioning of the revenue cycle processes within a healthcare organization
You will oversee various aspects of revenue cycle operations, including patient registration, charge capture, coding, billing, claims processing, denial management, and accounts receivable follow-up
Your primary goal will be to optimize revenue generation, maximize collections, and minimize denials to ensure the financial health of the organization
Responsibilities:
Revenue Cycle Oversight:Manage and supervise the revenue cycle operations, ensuring compliance with regulatory requirements and industry best practices
Develop and implement strategies to optimize revenue generation and enhance cash flow
Monitor key performance indicators (KPIs) and financial metrics to identify trends, areas for improvement, and potential revenue leakage
Collaborate with cross-functional teams, such as clinical departments, finance, coding, and compliance, to streamline revenue cycle processes
Billing and Claims Management:Oversee the timely and accurate submission of claims to third-party payers, including Medicare, Medicaid, commercial insurance companies, and self-pay patients
Monitor claim status and work closely with the billing team to resolve any coding or billing discrepancies
Analyze denial patterns, identify root causes, and implement corrective measures to minimize denials and maximize collections
Stay updated with changes in healthcare regulations, payer policies, and coding guidelines to ensure compliance and accurate billing
Accounts Receivable Management:Review and analyze accounts receivable aging reports to identify delinquent accounts and take appropriate actions for timely payment
Implement strategies for effective accounts receivable follow-up, including phone calls, appeals, and negotiations with payers and patients
Collaborate with the finance team to reconcile payments, identify posting errors, and resolve outstanding balances
Provide guidance and support to the team in resolving complex billing and reimbursement issues
Process Improvement:Continuously assess revenue cycle processes, identify inefficiencies, and recommend process improvements to enhance operational efficiency and revenue integrity
Implement automation and technology solutions to streamline workflows and reduce manual intervention
Conduct regular audits and reviews to ensure compliance with coding guidelines, billing regulations, and internal policies
Develop and deliver training programs to educate staff on revenue cycle best practices, coding updates, and compliance requirements
Qualifications:Bachelors degree in Healthcare Administration, Business Administration, or a related field (master's degree preferred)
Experience in revenue cycle management or healthcare finance
Strong knowledge of healthcare reimbursement systems, billing regulations, and coding guidelines (eg, CPT, ICD-10, HCPCS)
Proficiency in using revenue cycle management software and electronic health record (EHR) systems
Familiarity with third-party payer requirements, including Medicare, Medicaid, and commercial insurance
Excellent analytical and problem-solving skills with the ability to interpret financial data and identify trends
Strong leadership and team management abilities
Effective communication and interpersonal skills to collaborate with various stakeholders
Certified Professional Biller (CPB) or Certified Revenue Cycle Specialist (CRCS) certification is a plus
Note: The above job description is a general outline and may vary depending on the organization and its specific requirements
