Revenue Cyle Manager Lower Sioux Indian Community
Lower Sioux, Juneau, AK, United States
JOB TITLE
Revenue Cyle Manager
DEPARTMENT
Lower Sioux Health Care Center
REPORTS TO
Health Services Director
LOCATION
Lower Sioux Health Care Clinic
FLSA STATUS
Non- Exempt / Fulltime
HOURS
Monday – Friday 8:00am to 5:00 pm, may occasionally require evenings and weekends.
SALARY
Dependent on Experience
SUMMARY
The Revenue Cycle Manager is responsible for managing the timely and accurate submission of LSIC claims to third party payers and the management of rejected claims. Collaborates with the LSIC Finance team to do predictive financial modeling for all LSIC program strategic initiatives.
EDUCATION AND EXPERIENCE
Bachelor’s degree in business or related field required with three (3) to five (5) years’ experience with third party payment, claims submission and management, and ICD-10 coding. Master’s degree preferred.
Registered Health Information Administrator (RHIA) preferred
Three (3) to five (5) years of supervisory experience and background in business office management, preferably in a medical clinic required.
Demonstrated understanding of MS Office, electronic billing software and related software programs.
Demonstrated understanding of LSIC policies and procedures for coding, billing and the management of the related processes that comply with state and federal compliance.
Demonstrated understanding of all third-party claims’ submission processes.
Working knowledge of ICD-10 and CPT/HCPC’s coding to interpret and manage claims in a timely and accurate manner.
Demonstrated ability to establish and maintain relationships with the third-party payer community and related stakeholders to ensure resolution of outstanding claims.
Demonstrated ability to analyze complex medical record documentation and identify and submit for billable services.
Exceptional organizational skills and experience with database management.
Ability to gather data, compile information and prepare reports to meet regulatory compliance.
Ability to maintain strict confidentiality of patients, medical, clinic and LSIC information.
Knowledge and experience working with Native American communities, culture, customs, and tribal public health preferred.
Must have current driver’s license, reliable personal transportation, proof of current insurance coverage, and insurability under the tribe’s auto insurance policy.
Any employment offer is contingent on results of a drug and alcohol test and a health care background check as required by Centers for Medicare Services, as a condition of obtaining employment.
American Indian/Alaska Native preference applies to equally qualified candidates.
Must pass background checks allowing the individual to work in a Minnesota health care facility.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Leads staff in the timely and efficient billing and management of third-party claims.
Monitors the status and progress of work, make day-to-day adjustments in accordance with established priorities.
Instruct employees in specific tasks and job techniques and make available written instruction, reference materials and supplies. Ensuring that required policies and procedures and regulations are being implemented and managed.
Provides orientation for new employees, manages performance and identifies training needs for employees.
Responsible for the timely and accurate submission of claims to third party payers and intermediaries.
Responsible for management of rejected claims.
Reviews reports to identify claim trends and mitigate any delays in submission or payment. Communicates all claims unbillable, along with reason and makes recommendations for mitigation of future trends.
Documents all activity performed on patient accounts in the billing system.
Responsible for maintaining currency in third party payer trends, legislation and regulations.
Demonstrated ability to understand and implement applicable Federal, State and Tribal regulations and statutes.
Provides guidance and leadership to department staff in the interpretation of denials, codes and other information necessary to expedite billing third party payers.
Actively participates in department meetings, committees and conferences.
Actively participates in the financial analysis of all strategic initiatives to ensure there is strong understanding of expense and revenue prior to planning and implementation.
Research analyzes and resolves inquiries from providers and patients regarding fees, reimbursement and denials.
Maintains current knowledge of ongoing changes of benefit plans, eligibility, and coverage criteria.
Maintains strictest confidentiality.
Complies dress code and maintains a professional image.
May serve on committees, task forces or advisory groups that service or have connection with the Lower Sioux Indian Community.
Assumes responsibility for self-development.
Participates in continuing education programs, workshops and conferences and adheres to licensing requirements.
Other duties as assigned by Supervisor.
SKILLS KNOWLEDGE AND ATTRIBUTES
Strong written and verbal communication skills.
Information exchanges often involve complex issues. Incumbent must be able to explain the information given due consideration to the knowledge base of the recipient.
Must be able to communicate effectively with a variety of individuals including but not limited to patients, third party payers, and outside agencies.
Must be able to establish relationships built on trust and professional demeanor.
Ability to understand the needs of both the Lower Sioux Indian Community and the organizations the Lower Sioux Health Care Clinic, Community Health, and Human Services Programs.
Must be able to represent the Tribe to outside organizations and agencies in a professional and courteous manner.
Must be able to conduct self in a professional manner reflecting the Tribe’s mission, philosophy and values.
Strong contributor in team environments.
DISCLAIMER
This is not necessarily an exhaustive list of all the responsibilities, skills, duties, requirements, efforts or working conditions associated with the job. While this is intended to be an accurate reflection of the current job, management and Community Council reserves the right to revise the job or to require that other or different tasks be performed when circumstances change (e.g., emergencies, changes in personnel, workload, rush jobs or technical developments).
#J-18808-Ljbffr
Revenue Cyle Manager
DEPARTMENT
Lower Sioux Health Care Center
REPORTS TO
Health Services Director
LOCATION
Lower Sioux Health Care Clinic
FLSA STATUS
Non- Exempt / Fulltime
HOURS
Monday – Friday 8:00am to 5:00 pm, may occasionally require evenings and weekends.
SALARY
Dependent on Experience
SUMMARY
The Revenue Cycle Manager is responsible for managing the timely and accurate submission of LSIC claims to third party payers and the management of rejected claims. Collaborates with the LSIC Finance team to do predictive financial modeling for all LSIC program strategic initiatives.
EDUCATION AND EXPERIENCE
Bachelor’s degree in business or related field required with three (3) to five (5) years’ experience with third party payment, claims submission and management, and ICD-10 coding. Master’s degree preferred.
Registered Health Information Administrator (RHIA) preferred
Three (3) to five (5) years of supervisory experience and background in business office management, preferably in a medical clinic required.
Demonstrated understanding of MS Office, electronic billing software and related software programs.
Demonstrated understanding of LSIC policies and procedures for coding, billing and the management of the related processes that comply with state and federal compliance.
Demonstrated understanding of all third-party claims’ submission processes.
Working knowledge of ICD-10 and CPT/HCPC’s coding to interpret and manage claims in a timely and accurate manner.
Demonstrated ability to establish and maintain relationships with the third-party payer community and related stakeholders to ensure resolution of outstanding claims.
Demonstrated ability to analyze complex medical record documentation and identify and submit for billable services.
Exceptional organizational skills and experience with database management.
Ability to gather data, compile information and prepare reports to meet regulatory compliance.
Ability to maintain strict confidentiality of patients, medical, clinic and LSIC information.
Knowledge and experience working with Native American communities, culture, customs, and tribal public health preferred.
Must have current driver’s license, reliable personal transportation, proof of current insurance coverage, and insurability under the tribe’s auto insurance policy.
Any employment offer is contingent on results of a drug and alcohol test and a health care background check as required by Centers for Medicare Services, as a condition of obtaining employment.
American Indian/Alaska Native preference applies to equally qualified candidates.
Must pass background checks allowing the individual to work in a Minnesota health care facility.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Leads staff in the timely and efficient billing and management of third-party claims.
Monitors the status and progress of work, make day-to-day adjustments in accordance with established priorities.
Instruct employees in specific tasks and job techniques and make available written instruction, reference materials and supplies. Ensuring that required policies and procedures and regulations are being implemented and managed.
Provides orientation for new employees, manages performance and identifies training needs for employees.
Responsible for the timely and accurate submission of claims to third party payers and intermediaries.
Responsible for management of rejected claims.
Reviews reports to identify claim trends and mitigate any delays in submission or payment. Communicates all claims unbillable, along with reason and makes recommendations for mitigation of future trends.
Documents all activity performed on patient accounts in the billing system.
Responsible for maintaining currency in third party payer trends, legislation and regulations.
Demonstrated ability to understand and implement applicable Federal, State and Tribal regulations and statutes.
Provides guidance and leadership to department staff in the interpretation of denials, codes and other information necessary to expedite billing third party payers.
Actively participates in department meetings, committees and conferences.
Actively participates in the financial analysis of all strategic initiatives to ensure there is strong understanding of expense and revenue prior to planning and implementation.
Research analyzes and resolves inquiries from providers and patients regarding fees, reimbursement and denials.
Maintains current knowledge of ongoing changes of benefit plans, eligibility, and coverage criteria.
Maintains strictest confidentiality.
Complies dress code and maintains a professional image.
May serve on committees, task forces or advisory groups that service or have connection with the Lower Sioux Indian Community.
Assumes responsibility for self-development.
Participates in continuing education programs, workshops and conferences and adheres to licensing requirements.
Other duties as assigned by Supervisor.
SKILLS KNOWLEDGE AND ATTRIBUTES
Strong written and verbal communication skills.
Information exchanges often involve complex issues. Incumbent must be able to explain the information given due consideration to the knowledge base of the recipient.
Must be able to communicate effectively with a variety of individuals including but not limited to patients, third party payers, and outside agencies.
Must be able to establish relationships built on trust and professional demeanor.
Ability to understand the needs of both the Lower Sioux Indian Community and the organizations the Lower Sioux Health Care Clinic, Community Health, and Human Services Programs.
Must be able to represent the Tribe to outside organizations and agencies in a professional and courteous manner.
Must be able to conduct self in a professional manner reflecting the Tribe’s mission, philosophy and values.
Strong contributor in team environments.
DISCLAIMER
This is not necessarily an exhaustive list of all the responsibilities, skills, duties, requirements, efforts or working conditions associated with the job. While this is intended to be an accurate reflection of the current job, management and Community Council reserves the right to revise the job or to require that other or different tasks be performed when circumstances change (e.g., emergencies, changes in personnel, workload, rush jobs or technical developments).
#J-18808-Ljbffr