JOB SUMMARY:

Reporting to the Sr. Manager Revenue Cycle, the Revenue Cycle Lead is a key member of the Revenue Cycle team. The Revenue Cycle Lead is responsible for maintaining the optimal performance of system applications, ensuring smooth navigation by upgrading the features of existing applications and performing diagnostic testing before releasing the applications within revenue cycle.

EDUCATION:

• Associate’s or Bachelor’s Degree in Healthcare Administration or related field of study preferred.

QUALIFICATIONS:

• Minimum of one to two years of supervisory or management experience in hospital and physician revenue cycle operations.

• Excellent working knowledge of medical insurance and billing procedures with understanding of HMO, PPO, Workers Compensation, Medicare, Medicaid and indemnity plans.

• Demonstrates advanced computer operational skills.

• Extensive experience of billing forms and electronic form submission requirements.

• Experience using hospital and practice management systems required; experience with CPSI and Medent billing software systems is a plus.

• Have excellent organization and time management skills.

• Have professional and effective communication skills.

• Strong Microsoft Office skills.

• Professional certification through HFMA, AAHAM, or MGMA preferred.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Addresses problems and issues identified by staff or insurance carriers of billing errors both electronically and on paper for CMS 1500 and UB04 forms.

• Creates and maintains the insurance carrier set up in both the physician and hospital practice management software. Communicates issues to manager through daily verbal communication and written status reports.

• Troubleshoot and coordinate system level issues with internal IT and vendor support resources.

• Identifies suboptimal patterns in physician and or revenue cycle behaviors to remedy errors by determining the appropriate solution.

• Reaches out to insurance carriers to resolve billing submission or acknowledgement issues.

• Stays current on industry regulations and best-practice revenue cycle operations.

LANGUAGE SKILLS:

Ability to communicate effectively with staff, peers, physicians, and the public. Ability to speak and understand English fluently.

MATHEMATICAL SKILLS AND REASONING ABILITY:

• Advanced Math/accounting skills.

• Attention to detail when entering numeric codes, policy numbers, etc.

PHYSICAL DEMANDS:

Light physical effort; some standing, walking, bending, reaching, stooping; manual dexterity to operate keyboard and other equipment; detail oriented; able to maintain a pleasant and courteous demeanor under all circumstances.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Experience

• Demonstrates advanced computer operational skills.
• Excellent working knowledge of medical insurance and billing procedures with understanding of HMO, PPO, Workers Compensation, Medicare, Medicaid and indemnity plans.
• Minimum of one to two years of supervisory or management experience in hospital and physician revenue cycle operations.

Education

• Bachelors or better
• Associates or better