Manager, Revenue Cycle at Long Tail Health Solutions

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Full Time

Start Date

Immediate

Expiry Date

21 Apr, 26

Salary

0.0

Posted On

21 Jan, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Revenue Cycle Management, Patient Registration, Insurance Verification, Coding, Billing, Claims Processing, Denial Management, Analytical Skills, Problem Solving, Leadership, Communication, Project Management, Customer Service, Organizational Skills, Critical Thinking, EHR Software

Industry

technology;Information and Internet

Description

Job Summary The Revenue Cycle Manager is responsible for overseeing all aspects of the revenue cycle. This includes managing patient registration, insurance verification, coding, billing, claims processing, and denial management. The role ensures financial performance by optimizing revenue cycle workflows, enhancing operational efficiency, and maintaining compliance with federal, state, and payer regulations. The manager will work collaboratively with clinical, financial, and administrative teams to drive improvements in revenue cycle operations and financial outcomes. Education and Experience Bachelor's degree in Healthcare Administration, Business, Finance, or a related field (Master's preferred). 5+ years of revenue cycle experience in an acute care hospital setting, with at least 2 years in a leadership role. Strong knowledge of hospital billing, coding (ICD-10, CPT, HCPCS), reimbursement methodologies (DRG, APC, Medicare/Medicaid, commercial payers), and revenue cycle compliance. Experience with EHR and revenue cycle management software (e.g., Epic, Cerner, Meditech). Strong analytical, problem-solving, and decision-making skills. Excellent communication and leadership abilities with experience managing teams. Experience leading revenue cycle optimization projects and implementing process improvements. Familiarity with value-based care reimbursement models and contract negotiations. Preferred certification in Revenue Cycle (CRCR, CHAM, or CPC) or related credential. Knowledge · Knowledge of regulatory requirements including HIPAA, CMS guidelines, and payer policies. Proficient with principles of all payer types including managed care, Medicare/Medicaid, and private insurer reimbursement rules. Knowledge of medical necessity criteria, payer reimbursement arrangements, and denials management. Skills Project management to ensure budgetary constraints and plan deadlines are met timely. Ability to oversee team and guide them to successful outcomes with work consistency, process improvement changes, and efficiency optimization. Advanced problem solving to address complex cases, reimbursement trends and quality assurance. Customer service for providing solutions to payers, patients, clients and team members. Organizational skills to manage multiple tasks balancing team’s strength to match department’s workload. Interpersonal skills to help interact and work with team and clients effectively. Critical thinking to optimize day to day assignments, make necessary decisions on high risk/high dollar cases and respond appropriately to demanding client and payer needs. Work Context A 100% remote work force will require very strong communication and remote relationship building skills. Primary Job Duties The essential functions include, but are not limited to the following: Interviews, hires, orients, trains, develops and evaluates the performance of and, when necessary, disciplines and/or discharges department personnel. Provides direction, as necessary, to staff regarding sensitive and/or complex work, related problems, resolves complaints and response to inquiries regarding department operations. Provides ongoing education and coaching of department staff Maintains a working knowledge of all current best practices for commercial and governmental payer denials management. Stay up to date with and disseminate current regulatory and payer trending information as formal education to appropriate staff. Evaluates team member comprehension and understanding of education. Oversee and manage phases of the revenue cycle, including patient access, utilization review, charge capture, coding, claims submission, payment posting, denial management, and collections. Develop and implement policies and procedures to enhance revenue cycle efficiency and reduce revenue leakage. Monitor key performance indicators (KPIs) such as clean claim rates, denial rates, days in accounts receivable (A/R), and reimbursement trends to ensure optimal financial performance. Analyze revenue cycle processes to identify opportunities for automation, process improvement, and cost reduction. Ensure accurate and compliant coding and documentation practices to maximize reimbursements and minimize denials. Collaborate with coding and clinical documentation improvement (CDI) teams to ensure proper charge capture and coding accuracy. Develop strategies to reduce denials and improve denial recovery efforts through root cause analysis and proactive process changes. Work with payers and internal teams to resolve claims issues, appeal denied claims and negotiate reimbursement rates when necessary. Work closely with finance, HIM (Health Information Management), patient access, and clinical teams to align revenue cycle processes with hospital operations. Serve as a liaison between the hospital and third-party payers to resolve payment disputes and maintain strong payer relationships. Optimize the use of hospital revenue cycle systems, including EHR, billing software, and financial reporting tools. Partner with IT to implement system upgrades, automation tools, and workflow enhancements. Ensure data integrity and accuracy in all revenue cycle-related reporting and documentation. Note This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.

Responsibilities

The Revenue Cycle Manager oversees all aspects of the revenue cycle, including patient registration, coding, billing, and claims processing. They work collaboratively with various teams to enhance operational efficiency and ensure compliance with regulations.