Revenue Cycle Manager will direct and oversee the overall policies, objectives, and initiatives of an organization's revenue cycle activities to optimize the patient financial interaction along the care continuum. Review, design, and implement processes surrounding admissions, pricing, billing, third party payer relationships, compliance, collections and other financial analyses to ensure that clinical revenue cycle is effective and properly utilized. Manage relations with payers and providers to generate high reimbursement rates and a low level of denials. Create functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure.
Essential Job Functions
- Establish and maintain a safe working environment; assure staff comply with safety, environmental, and infection control guidelines.
- Assure proper use of safety equipment and devices; hold individuals accountable if non-compliant.
- Assure completion of staff competencies including mandatory education and programs relative to job specific criteria.
- Promptly investigate and resolve Significant Occurrence Reports and incident reports as necessary.
- Align strategic compass with department goals; write compelling SMART goals in support of the organization's mission, vision, and values.
- Help employees understand importance of aligning goals with Excela Health mission.
- Equitably and consistently apply and practice policies and procedures for all staff.
- Practice and encourage staff readiness in compliance with agency regulations and guidelines.
- Improve HCAP scores according to fiscal year targets; demonstrate year over year improvement in service to internal and external customers.
- Respond to client service recovery issues within required time frame and to the satisfaction of the customer.
- Hold regular department meetings, assuring off shifts and satellite offices receive accurate information.
- Maintain a daily meeting board for purpose of displaying problem solving activity.
- Build and strengthen relations through the fostering of two-way communication; diffuse sources of conflict.
- Provide opportunities for staff to actively provide input into decision making process; seek input before decision is made.
- Encourage commitment of quality work throughout areas of responsibility.
- Understand and effectively deploy the LEAN tools to streamline work processes, eliminating waste and redundancy while improving productivity.
- Act on most urgent tasks; prioritize and delegate workable systems.
- Use critical thinking skills to proactively resolve issues that are de-railers to productivity and engagement.
- Lead at least one process improvement initiative for department per year; participate in at least one LEAN project per year outside of department.
- Clearly articulates what is expected of individuals and provides them with the materials and equipment to do their work.
- Adhere to productivity benchmarks for own department.
- Utilize employee engagement survey results in carrying out impact plans; demonstrate employee engagement by employee satisfaction results from survey to survey.
- Establish performance measures to equitably evaluate staff using objective and job-based criteria; coach toward compliance and addresses variances.
- Provide regular feedback, praise, and recognition; reward accomplishments and results appropriately.
- Hold staff accountable for consistently modeling the behavioral standards.
- Identify, evaluate, and select internal and external talent, assuring an acceptable fit with Excela Health desired culture; effectively match right person to right job.
- Provide opportunities for the education, training, and development of staff to help reach highest potential.
- Offer stretch assignments; create actionable development plans; encourage learning from setbacks and for future development.
- Actively support and participate in succession planning initiatives; identify high potentials and prepare them for possible future leadership opportunities within Excela Health.
- Take responsibility for own professional growth and development; attend required EHA leadership programs; network with colleagues to seek out best practices
- Introductory, transfer and periodic appraisals are required to be completed timely adhering to performance management guidelines. All Performance Management (introductory, transfer and periodic appraisals) must be completed in a designated electronic format.
- Consider financial impact of decisions; use financial concepts for decision making; monitor financial performance.
- Develop and manage department budget at or below budget expectations and consistent with adjusted volume variations.
- Identify and implement revenue enhancement opportunities.
- Seek opportunities to reduce operating costs while balancing quality resources.
- Submit timely variance reports that display knowledge of expenses and demonstrates continual plans to reduce variances; operate each year more effectively than one before.
- Stretch capital resources by extending life of existing assets.
- Coordinate the selection of vendors through established internal procurement procedures in an effort to drive down supplier costs while maintaining quality standards.
- Cognitive ability to function and concentrate on the essential and specialty functions of the job at a high level.
- Achieves thoroughness and accuracy when accomplishing an essential or specialty function of the job.
- Ability to think and concentrate for an entire shift.
Specialty Job Functions
- Direct and supervise the operations of Patient Billing and Collections, and cash posting, Hospital Admission and Verification.
- Develop and maintain reports to monitor registration accuracy.
- Direct the activities that define the process for producing claims that are compliant with federal, state and carrier regulations/requirements.
- Ensure that there are processes in place to control the various software products to edit and transmit claims.
- Review payer contracts and oversee development of processes to meet contractual language.
- Evaluate software to enhance the insurance verification, billing, collection and reporting processes.
- Monitor, plan and implement revenue cycle processes, including the days in AR.
- Work collaboratively with members of management to reduce unbilled accounts.
- Prepare monthly Revenue Cycle Scorecard.
- Keep abreast of revenue cycle indicators through list serves, participation in surveys, and audio conferences.
- Direct and monitor the debt collection activities.
- Ensure that computer systems generate collector work files to assure timely account and claim follow-up.
- Ensure that the bad debt process is effectively done.
- Review payer denials and directs efforts to reduce or eliminate them.
- Responsible for internal and external audits and regulatory reporting.
- Ensure that the Medicare Credit Balance reporting is done quarterly.
- Ensure that policies and procedures are in place for the Medicare 72-hour rule.
- Review the Tobacco Audits, oversee the MSP audits, and approve insurance audit results.
- Other duties as assigned.
Required Qualifications
- Associate Degree in related field and five (5) years of accounting or health-related field experience.
- Three (3) to five years’ experience in billing/revenue cycle.
- Strong leadership ability, good organizational skills, independent and critical thinking skills, and sound judgment.
- Strong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience.
Preferred Qualifications
- Bachelor’s Degree in Business Administration, Certified Revenue Cycle Representative
- 10 years’ experience in Healthcare AR Management.
License, Certification & Clearances
- PA Act 34 Pennsylvania Access to Criminal History Clearance.
Supervisory Responsibilities
- This position has direct supervisory responsibilities and serves as a coach and mentor for other positions in the department.
- Management responsibilities include hiring, coaching, skills development, recognition and rewards, staff productivity and performance management.
Position Type/Expected Hours of Work
- Regular, consistent, on-site and timely attendance.
- Incumbent will be scheduled based on operational need (rotate shifts, standby, on-call, etc.).
- Travel may be expected locally between Excela Health locations.
LEAN
- Actively promotes a Lean work culture by performing team member duties to encourage consistent use of LEAN principles and processes, including continually seeking work process improvements. Recognizes the necessity of taking ownership of one’s own motivation, morale, performance and professional development. Strives for behavior consistent with being committed to Excela’s missions, vision and values.
AAP/EEO
- Excela Health is an Equal Opportunity Employer. It is the policy of Excela Health to prohibit discrimination of any type and to afford equal employment opportunities to employees and applicants, without regard to race, color, religion, sex, national origin, age, marital status, non-job related disability, veteran status, or genetic information, or any other protected class. Excela Health will conform to the spirit as well as the letter of all applicable laws and regulations.
- Ability to perform the Essential Functions listed on the Physical Conditions and ability to perform the Essential Functions on the Working Condition chart below.
Work Environment
Effective March 2020 or during pandemic: goggles, face shield and mask are required according to CDC guidelines
When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.
Essential – Absolute Necessity.
Marginal – Minimal Necessity.
Constantly – 5.5 to 8 hours or more or 200 reps/shift.
Frequently – 2.5 to 5.5 hours or more or 32-200 reps/shift.
Occasionally – 0.25 to 2.5 hours or 2-32 reps/shift.
Rarely – Less than 0.25 hours or less than 2 reps/shift.
Physical Condition
Essential
Marginal
Constantly
Frequently
Occasionally
Rarely
Never
Extreme Heat
X
X
Extreme Cold
X
X
Heights
X
X
Confined Spaces
X
X
Extreme Noise(>85dB)
X
X
Mechanical Hazards
X
X
Use of Vibrating Tools
X
X
Operates Vehicle (Company)
X
X
Operates Heavy Equipment
X
X
Use of Lifting/Transfer Devices
X
X
Rotates All Shifts
X
X
8 Hours Shifts
X
X
10-12 Hours Shifts
X
X
On-Call
X
X
Overtime(+8/hrs/shift; 40/hr/wk)
X
X
Travel Between Sites
X
X
Direct Patient Care
X
X
Respirator Protective Equipment
X
X
Eye Protection
X
X
Head Protection (hard hat)
X
X
Hearing Protection
X
X
Hand Protection
X
X
Feet, Toe Protection
X
X
Body Protection
X
X
Latex Exposure
X
X
Solvent Exposure
X
X
Paint (direct use) Exposure
X
X
Dust (sanding) Exposure
X
X
Ethylene Oxide Exposure
X
X
Cytotoxic (Chemo) Exposure
X
X
Blood/Body Fluid Exposure
X
X
Chemicals (direct use) Exposure
X
X
Mist Exposure
X
X
Wax Stripper (direct use)
X
X
Non-Ionizing Radiation Exposure
X
X
Ionizing Radiation Exposure
X
X
Laser Exposure
X
X
Physical Demands
When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.
Essential – Absolute Necessity.
Marginal – Minimal Necessity.
Constantly – 5.5 to 8 hours or more or 200 reps/shift.
Frequently – 2.5 to 5.5 hours or more or 32-200 reps/shift.
Occasionally – 0.25 to 2.5 hours or 2-32 reps/shift.
Rarely – Less than 0.25 hours or less than 2 reps/shift.
Physical Condition
Essential
Marginal
Constantly
Frequently
Occasionally
Rarely
Never
Bending (Stooping)
X
X
Sitting
X
X
Walking
X
X
Climbing Stairs
X
X
Climbing Ladders
X
X
Standing
X
X
Kneeling
X
X
Squatting (Crouching)
X
X
Twisting/Turning
X
X
Keyboard/Computer Operation
X
X
Gross Grasp
X
X
Fine Finger Manipulation
X
X
Hand/Arm Coordination
X
X
Pushing/Pulling(lbs. of force)
X
X
Carry
X
X
Transfer/Push/Pull Patients
X
X
Seeing Near w/Acuity
X
X
Feeling (Sensation)
X
X
Color Vision
X
X
Hearing Clearly
X
X
Pulling/Pushing Objects Overhead
X
X
Reaching Above Shoulder Level
X
X
Reaching Forward
X
X
Lifting Floor to Knuckle
X
Up To 19 #
20+ #
Lifting Seat Pan to Knuckle
X
Up To 19 #
20+ #
Lifting Knuckle to Shoulder
X
Up To 19 #
20+ #
Lifting Shoulder to Overhead
X
Up To 19 #
20+ #
When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required
