RCM Manager
Requisition ID 2024-107243
Position Type (Portal Searching) Regular Full-Time
Overview
HealthPro Heritage has a great opportunity available for a Remote Revenue Cycle Manager!
RCM Manager- is responsible oversight of AR/Billing Team, Coding team, Cash Posting team, Verification/Authorization team(s) and PFS-Customer Service Team and any Vendor teams.  Working closely with Senior Director to ensure KPI’s, strategic vision and changes are met.
Why Choose HealthPro Heritage?
• Purpose-Driven Work: Be part of a mission-driven organization dedicated to compassionate care and innovative therapy solutions.
• Growth Opportunities: Enjoy continuous learning and development opportunities tailored to support your professional growth.
• Collaborative Culture: Thrive in a supportive environment where teamwork, respect, and open communication are at the heart of everything we do.
• Commitment to Excellence: Join a team recognized for clinical expertise and commitment to delivering high-quality care and outcomes.
• Competitive Benefits Package: Enjoy competitive compensation along with a comprehensive benefits package designed with YOU in mind!
Join Us in Making a Difference
At HealthPro Heritage, we offer a fulfilling career where you can positively impact lives and achieve personal and professional growth. As a therapist-led, diverse organization, we provide clinical services across various settings, including nursing facilities, retirement communities, hospitals, home care, and pediatric schools and clinics. Join us to be part of a team that values your skills, listens to your input, and makes a meaningful difference in the community.
Responsibilities
• Responsible for various aspects of management, support and oversight of Vendors, AR/Billing team, Cash Posting Team, Verification/Authorization team(s) and PFS-Customer Service team.
• Assist Director in developing various KPI’s, and metrics for the RCM-Senior Living Team.
• Responsible to work with RCM Supervisors on various employee related HR issues for resolution.
• Assist in developing necessary Policy and Procedures for the RCM-Senior Living Team(s).
• Ability to work in various billing systems and/or clearinghouses as needed.
• Assist in development of various workflows and training documentation as needed.
• Ability to interpret various RCM reports and data in order to make managerial and strategic decisions.
• Reviews, interprets, and applies and/or approves contractual terms and identifies and/or applies contractual and/or administrative adjustments.
• Monitor insurance denials by running reports and working with various RCM teams to resolve and recover and/or minimize denied claims.
• Performs retroactive review of registration/front end data to aid in the assurance of clean claim submittal.
• Serves as a resource for problem solving issues related to all areas of the Senior Living Revenue Cycle Teams.
• Works collaboratively with and communicates appropriately with all HPH teams/team members.
• Maintain department processes and controls according to Professional Coding Standards, CMS Standards, HIPAA, OIG, and the State guidelines as well as national payor coding guidelines as they pertain to professional coding and reimbursement.
• Communicate with Director/Clinical and compliance team to ensure accuracy on all documentation and encounter forms.
• Complying with medical coding guidelines and HealthPRO Heritage policies. Ensuring codes are accurately assigned and sequenced correctly in accordance with government and insurance regulations.
• Demonstrate understanding of National and Local Coverage Determinations as per MAC region and communicate those as necessary to PM’s, RVP, SVP’s and compliance team as needed.
• Ability to maintain the confidentiality of PHI as per HIPAA and HPH requirements.
• Exhibit sound knowledge of anatomy and physiology, medical terminology, patient care documentation terminology.
• Researching information in cases where the coding is complex or unusual. Disseminate information regarding new or updated codes and/or coding policies either by payer or through guidelines and regulations.
• Oversite of insurance denials, analyzing Explanation of Benefits (EOB)/ Electronic Remittance Advice (ERA) forms to ensure insurance companies have properly paid for charges. Identifying denial trends and communicating them to Senior Director for review.
• Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing.
• Maintain current credentials through continuing education CEU’s as per certification requirements.
• Other duties as assigned .
HealthPro Heritage is an Equal Opportunity Employer. We consider all qualified candidates for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other characteristic protected by law. Our employment decisions, including those related to hiring, promotion, and compensation, are made based on individual qualifications, performance, and organizational needs.
Qualifications
• Strong leadership skills with experience in maintaining positive culture with teams led.
• Able to demonstrate calm under pressure.
• Demonstrated coding (ICD-10-CM, CPT and HCPCS) expertise.
• Computer literacy of medical information systems, records management software, encoders.
• Good computing knowledge in Microsoft Outlook, Word, Excel, PowerPoint etc.
• Excellent communication and customer service skills, both verbal and written.
• Understanding of third-party reimbursement rules and regulations.
• Strong understanding of Insurance CARC/CAS denial codes.
• Medical Billing experience required.
• Outstanding organizational, detail oriented and time management skills.
• Excellent typing and 10-key speed and accuracy.
• 5+ Years of RCM related management experience.
• Current medical coding certification CPC, CCS-P, RHIA or other nationally recognized coding credential.
• 2+ years of work experience as a medical coder. Professional Physician (ProFee) coding experience, preferred.
• Experience with Net Health and Waystar preferred.
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