Manager, Revenue Cycle

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  • Norfolk, VA
  • Medical Tower
  • Insurance Clearance
  • Full -time - Days
  • 32822
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Summary

GENERAL SUMMARY
 
The Manager, Revenue Cycle is responsible for managing the full revenue cycle for the select Children’s Medical Group (CMG) and Children’s Surgical Specialty Group (CSSG) practices as part of a centralized service line. Works directly with the referring physician offices, outpatient services, payers and patients using reporting tools and auditing techniques to identify denial issues and trends by staff member, clinical area, payer and provider. Serves as a primary liaison with training and education specialists to obtain sustainable outcomes in areas of opportunity. Plans, organizes and directs daily operations of the billing office and the front end Insurance Clearance Department.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Establishes processes and procedures as part of the patient access function and is dedicated to completing patient access workflows related to improve financial outcomes to decrease first pass denials.
  • Audits of patient’s data capture and financial responsibilities prior to the provision of care.  Dedicated to creating standardized workflows relating to improving financial outcomes to decrease first pass denials and increase point of service collections across CHKD Health System.
  • Identifies process improvements with Denial Prevention Group (DPG) and prepares presentations to provide timely feedback to obtain desired outcomes. Serves as a primary liaison with training and education specialists to obtain sustainable outcomes in areas of opportunity. Reports results to the appropriate leadership areas and DPG.
  • Plans, organizes and directs daily operations of the billing office.  Obtains guidance from the Director and/or upper management for unusual or unanticipated circumstances that require deviation from financial/operational policies and standards of practice.  
  • Delegates, supervises personnel, operationalizes, solves problems, makes decisions and develops systems and processes for successful integration and implementation across the health system.
  • Responsible for accurate, timely and compliant billing practices. 
  • Monitors and prepares accurate reports of billing operations and practices.
  • Plans, organizes and provides oversight of financial clearance functions for all health system service areas.
  • Creates and implements the Financial Clearance Department for the Health System.
  • Partners with the DPG facilitator to complete data deep dives and identify trends, root causes, corrective actions and present outcomes at the DPG meeting.
  • Monitors and prepares accurate reports of the Health System Revenue Cycle operations and practices.

LICENSES AND/OR CERTIFICATIONS

None required.
 
MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS
  • Bachelor’s degree in a related field and/or 5 years relevant experience.
  • Knowledge of insurance requirements and guidelines.
  • Ability to identify problems independently and as part of a team, and implement solutions in multi-task, complex situations.
  • Solid people management and interpersonal skills necessary to successfully manage a large team and meet deliverables. Demonstrated success attracting and developing talent.
  • Technical and professional knowledge and skills unique to the business for designated services.
  • Must possess excellent leadership, communication, and analytical skills with the ability to plan, supervise establish and maintain a professional and productive work environment.
  • Proven success developing and maintaining effective relationships with customers and stakeholders.

WORKING CONDITIONS

  • Normal office environment with little exposure to excessive noise, dust, temperature and the like.
PHYSICAL REQUIREMENTS
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