POSITION SUMMARY: Under general supervision of the Controller, the Revenue Cycle Manager is a leadership position in the Fiscal Department responsible for directing and coordinating the overall functions of the billing, coding and provider credentialing activities of the organization. The billing office includes both internal staff and an external billing and coding vendor relationship.

ESSENTIAL JOB FUNCTIONS: The list that follows is not intended as a comprehensive list, but rather to provide a representative summary of the major duties and responsibilities. Incumbent(s) will be required to perform a variety of duties listed, including but not limited to:

Supervise billing office functions such as billing, coding, charge entry, claims submissions, payment posting, accounts receivable follow-up and reimbursement management.

Collaborate with billing office and clinical front office staff to ensure timely and accurate billing.

Plans and directs patient insurance documentation, workload coding, billing and collections to ensure accurate billing and efficient account collections.

Manage the company’s outside Billing and Coding vendor.

Analyzes billing and claims for accuracy and completeness; submitting claims to proper insurance entities (Government and Commercial) and follow up on any payment issues.

Develops and maintains a system for adjustment analysis, reviews and monitors all denials and works with Billing Supervisor on follow up claim activity.

Develops and maintains billing office policies and procedures regarding coding, patient billing, collections efforts to ensure compliance with applicable billing and collection laws.

Audits billing processes to monitor and improve efficiency of billing and collection operations.

Maintains fee schedule within the electronic health record.

Develops and provides in-house training for clinic front office and support staff, records staff and providers regarding administrative processes and procedures related to billing and coding.

Prepares and analyze accounts receivable as well as other financial reports and billing related Key Performance Indicators (KPI).

Analyzes trends impacting charges, coding, collection, and accounts receivable and takes appropriate actions to realign staff and revise policies and procedures, as necessary.

Completes applications, as necessary, for payer enrollment and re-validation.

Collaborate with third party credentialing vendor to ensure providers are timely and correctly credentialed.

Coordinates the completion of annual OSHPD reports and Medi-Cal clinic reconciliations.

Understands and remains updated with current coding and billing regulations and compliance requirements.

Other duties as assigned.

All NVIH employees are expected to:

- Provide the highest possible level of service to patients;

- Promote teamwork and cooperative effort among employees;

- Maintain safe practices; and

- Abide by current NVIH’s policies and procedures.

REQUIRED QUALIFICATIONS

The following knowledge, skills, and abilities are required for an employee to successfully perform their duties.

1. Associates Degree, preferable in business administration. Bachelor’s Degree in business administration, healthcare administration or related field, preferred.
2. Minimum of five (5) years’ medical insurance/healthcare revenue cycle experience in health care organization; preferably a Federally Qualified Health Clinic or other high volume/large outpatient clinical organization.

Minimum of three (3) years of supervisory experience with demonstrated leadership skills in supervising, coaching, counseling and managing performance of support staff.

3. Working knowledge of front office and medical records processes in an outpatient clinical setting.
4. Must be familiar with governmental accounting in accordance with U.S. Generally Accepted Accounting Principles (GAAP) and Government Accounting Standards Board (GASB).
5. Working knowledge and experience operating in Electronic Health Record.

eClinical Works (eCW) preferred, but not required.

6. Exceptional verbal and written communication skills
7. Skill in establishing and maintaining positive and effective working relationships with department directors, and others contacted in the course of the work.

8. Skill in analyzing complex and sensitive financial forecasting, budgetary, and economic issues, evaluating alternatives and reaching sound conclusions.

9. Working knowledge of Microsoft Office products such as Word, Excel and Power Point.

10. Ability to operate general office equipment such as copiers and faxes in a clinical setting.
11. Reliable Transportation and ability to adhere to regular attendance.

Medical, Dental, Vision, Life Insurance, 401K, 4 weeks PTO, 13 Holidays, Flexible Scheduling