Under the general direction of the Director of Finance, the Revenue Cycle Management (RCM) Director effectively leads billing, collection, compliance, and accounts receivable management team while maintaining a full understanding of Valley Health Team’s billing system and all aspects of community health center revenue cycle management. The Director will manage the activities of the centralized billing and collection staff by overseeing all billing and accounts receivable functions. Billing will include payer sources such as: Medi-Cal, Medi-Cal Managed Care, Medicare, Private Insurance, Private Pay, and other third party in accordance with established policies and procedures. This individual will create and implement policies and procedures toward productive function of department; implementation and monitoring of performance goals and objectives; ensure accurate posting of financial activity; maintenance of good interdepartmental communication.
DUTIES AND RESPONSIBILITIES:
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Direct staff to ensure that accurate submission of all claims and timely collections occurs in accordance with established internal and third party payer requirements and in compliance with established policies, regulations, procedures and standards.
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Establish and maintain all billing and financial data, including medical billing code tables, rate schedules and payer information.
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Maintain, analyze and report on key revenue metrics and departmental and payer revenue performance indicators, proactively communicating and solving revenue-related issues; identify trends for further review.
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Ensure timely and accurate billing and collections activity. This is to include assisting staff members who are
backlogged and ensuring the proper distribution of work throughout the department.
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Assure maximization of cash collections through diligent and timely monitoring of all open accounts receivable
balances.
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Prepare detailed analyses and reports of billing and accounts receivable activity and results, including
performance matrixes, bad debt expense, denials management and AR days outstanding. Review and analyze aging reports on a monthly basis; assists in receivable process accordingly. Distribute aging reports to staff for follow up on billing activities. Ensure that the Advanced Collection program is appropriately utilized to maximize collection.
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Maintain, enhance and ensure billing practices are in compliance with policies and procedures for each function in the revenue cycle process and ensure staff adherence to policies.
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Serve as a liaison between the CEO, Finance Department and clinical departments on billing and revenue cycle matters, enhance awareness of providers on ways to strengthen revenue cycle performance; train First Impression Representatives and other patient service representatives to improve revenue generation efficiencies.
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May assume some direct billing/collections responsibility as a working supervisor with the workload approved by the CEO.
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Establish and implement annual goals, performance standards for all billing functions that align with VHT’s vision and business goals; identify external benchmarks, and provide complete analysis and suggestion for improving performance and goals.
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Provides mentoring, coaching and performance review of billing staff.
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Manage all billing operations, including hiring, orientation, training, development, coaching, corrective actions,
and ongoing monitoring of all staff work-related activities. Attend leadership and provider meetings.
BOARD APPROVED: PENDING REVIEW
Job Description: Billing Manager, Page 2
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Ensures consistent quality of the billing services by distributing and assigning duties and responsibilities to employees, ensuring skill levels are appropriate to the assigned tasks, and monitoring the department’s productivity.
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Established collaborative relationships with Medi-Cal and Medicare managed care organizations and insurance companies to solve problems, and improve reimbursements.
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Maintain accurate ICD-9/ICD-10 and CPT codes and keeping abreast of updates and changes to ensure proper medical coding and billing procedures.
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Ensure phone and personal interactions with patients who have questions regarding their accounts are handled in a customer-oriented manner and follow-up within an appropriate timeframe.
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Maintain accurate records as required for each program.
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Review the closing of the month and run all reports needed and as required by regulations and funding agencies.
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Ensure that reports are balanced and numbers posted match with the activity done.
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Prepare reports and information needed for any reconciliation by funding programs.
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Provide or facilitates the training for billing and as appropriate, front office personnel.
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On a temporary basis, may be required to work at any satellite facility.
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Contribute to team effort by assisting other departments as needed and while maintaining confidentiality of
VHT’s business.
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Work cooperatively with all staff members and outside sources in a professional manner to deliver a high level
of service.
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Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state,
and local requirements including OSHA, HIPAA, and CLIA, and The Joint Commission Accreditation of
Healthcare Organization standards.
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Observe and practice all VHT Patient Experience Service Standards as outlined in “World Class Practices: My
Commitment to Care (which I have read and signed). Practice CICARE when interacting with patients, their
families, visitors, or internal customers.
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Practice CICARE phone etiquette during all phone interactions.
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Always exercise courtesy whenever patients, family members, visitors and co-workers are present.
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Respect privacy and dignity of our patients, family members, visitors and co-workers.
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Maintain professionalism in the presence of patients, their families, visitors and co-workers.
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Act as a role model, verbally and behaviorally demonstrating skill, enthusiasm, positive problem solving,
commitment and loyalty to the profession and the organization.
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Perform other related duties, which may be inclusive, but not listed in the job description.
MINIMUM QUALIFICATIONS:
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A minimum of two (2) years of college and/or an Associate Degree with at least three years work experience in medical billing and collections or at least five (5) years work experience in medical billing and collections
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A minimum of three (3) years management experience, both department operations and staff
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Demonstrated knowledge of billing and specialty programs such as: CHDP, CDP, SOFP, Medi-Cal, Managed
Medi-Cal, Medicare and Private Insurance
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Must have thorough knowledge, training, and experience in using medical/dental terminology
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Must be computer literate and have working knowledge of computerized billing, practice management systems,
and MS Office Suite (e.g. Word, Excel, etc.)
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Be self-motivated and have the ability to prioritize work and meet deadlines
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Strong customer service skills (preferably within a service industry) and maintain an effective and positive
working relationship with staff and customers
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Knowledge of federal laws and regulations affecting coding requirements
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Knowledge of billing practices required, FQHC billing preferred
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Knowledge of Electronic Health Records – NextGen experience strongly preferred
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Excellent oral and written communication skills – be able to provide information in a clear and concise manner;
good interpersonal skills
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Ability to be flexible with work schedule and available to work at all site locations