Revenue Cycle Manager in Philadelphia, PA at Public Health Management Corporation

Date Posted: 2/19/2021

Job Snapshot

Job Description

Mission Statement:

Our Mission is to be the premier regional provider of integrated, community-based healthcare  by combining evidence-based clinical practices, outstanding patient service, innovative care partnerships, and team-driven excellence, within a healthy fiscal environment.

Summary Job Description:  

The Revenue Cycle Manager provides oversight and guidance to the administrative operations and clinical support functions associated with claims processing, payment, and revenue generation for the PHMC Behavioral and Community Health Network.  This position supports the growth of the health network through collaboration across the clinical, administrative, and clerical teams associated with providing healthcare services to diverse communities. This position reports to the Sr. Enterprise Budget and Reimbursement Controller.

Essential Duties and Responsibilities:

  • Supervises and oversees all activities of PHMC’s in house billing company to efficiently manage the back-end office tasks relating to claims reimbursements, payment posting, statement processing, collections, and claims denials.  Supervises a team of one billing supervisor, four billing coordinators, and one billing associate.
  • Determines and maintains billing schedules ensuring billing occurs in a timely and organized fashion.
  • Establishes and monitors all front-end processes relating to patient registration, insurance verification, point of service collections and pre-authorization to support an efficient and successful revenue cycle process.
  • Reviews and manages Behavioral Health and Community Mental Health performance metrics to optimize revenue cycle processes, and monitor efforts to ensure data integrity.
  • Works closely with the Behavioral Health and Community Mental Health Administrators and Program Directors to assure a strong front-end billing operation at PHMC’s Behavioral Health and Community Mental Health programs. 
  • Collaborates with management and clinical teams in establishing and maintaining key performance indicators for the revenue cycle operations. 
  • Utilizes statistical reports, and other analytical tools to track claims through the entire lifecycle, ensuring payments are collected and determining the root cause of denied claims.
  • Utilizes technology and other tools to strategize with the revenue cycle team in identifying, developing, and implementing systems and process improvements to promote more efficient revenue cycle operations— appointment scheduling, patient pre-registration, point of service registration and collections, encounter utilization review, charge capture and coding, claims submissions, third party follow-up, remittance processing and rejections.
  • Develops, implements, and updates policies and procedures to ensure efficient operations to maximize PHMC Behavioral Health/Community Mental Health Network revenue. 
  • Chief liaison with PHMC funders including CBH.

PHMC Compliance Responsibilities:

  • Understands and adheres to PHMC compliance standards as they appear in the PHMC Code of Conduct, Whistle Blowers and Conflict of Interest Policies. 
  • Keeps abreast of all pertinent federal, state and PHMC regulations, laws, and policies as they presently exist and as they change or are modified.
  • Comply with HIPAA and Confidentiality Policies and Procedures as they apply to the job
  • Comply with Department of Public Health (DPH), The Joint Commission and other accreditation and regulatory agencies standards.
  • Adhere to all PHMC Policies and Procedures.
  • Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as described in the annual education module.

Job Requirements:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Skills:

  • Ability to communicate positively and effectively verbally and in writing with diverse internal and external stakeholders.
  • Ability to work independently, with minimal supervision, in establishing priorities and managing multiple and competing deadlines.
  • Proficient with computer systems and spreadsheets
  • Strong interpersonal skills
  • Strong analytical skills
  • Strong organization of work tasks, project coordination and management 
  • Attention to detail

Experience:

  • Three or more years relevant experience required
  • Ability to process and maintain confidential matters and information
  • Able to serve as a strong technical resource
  • Two or more years of supervisory experience
  • Active Billing and Medical Coder Certifications

Education:

  • Bachelors Degree Required
  • Masters Degree Preferred

Physical Demands:

  • Position requires standing 2/3 of the time, walking 2/3 of the time, requires sitting under 1/3 of the time, use of hands to finger, handle or feel 2/3 of the time, reach with hands and arms, under 1/3 of the time, talk or hear over 2/3 of the time.  

Work Environment:

  • Moderate noise (examples: business office with computers and printers, light traffic).

Salary:

  • Based on education and experience
  • Grade 22