Job Description Summary:

Manages a RCM team who are responsible for all related medical billing activity for the purpose of maximizing accounts receivable collections for clients. In addition to performing similar work, the Manager will oversee and ensure group productivity and performance in accordance with financial goals to ensure the health of the client's Accounts Receivable Supports RCM Management by efficiently and effectively providing oversight and review of the team, processes and workload

Job Decription:

Responsible for staff productivity for follow-up of all unpaid, denied, and underpaid and overpaid claims. This includes but is not limited to: contacting insurance companies for claim status, reviewing all insurance claims and patient documentation, reviewing and ensuring appropriate coding, handling correspondence, and making appropriate decisions for follow-up action. Must be effective at handling several accounts simultaneously and ensuring maximum accounts receivables and expedient collection turnaround for clients.
Meets with Client representatives to review billing progress, status of a accounts and review and resolve any issues presented by clients.
Ensures that staff and/or vendor, as applicable enters all charges into the medical billing system accurately and correctly for reimbursement. This includes but is not limited to: ensuring correct CPT codes, modifiers, and ICD codes, authorizations for services, patient demographics, and health insurance data.
Responsible for staff who enters all patient, insurance, and third party payments into the medical billing system. This includes a thorough knowledge and understanding of medical EOB's, patient deductibles and co pays, and insurance or third party correspondence, contractual payments and adjustments.
Interact with clients and their patients, engage in proactive resolution of issues and timely response to questions and concerns.
Strong customer service skills for client satisfaction, health of client AR and management of RCM team members
answering client inquiries; prompt return and follow up to all interactions; prompt response to requests for information, both internally and externally
acts as primary point of contact for team members and provides guidance on work matters
Deliver timely required reports to the RCM Management; initiates and communicates the resolution of issues
Meet regularly with staff; in-person and as a group to confirm the status of client accounts and build/sustain staff engagement to drive business results and improvements
Knowledge, Skills and Abilities
Extensive knowledge with email, search engines, Internet
Abitlity to effectively use payer websites and LaserFiche
Intermediate practical knowledge and use of Microsoft products; Outlook, Word, Excel, Powerpoint
Preferred experience with MS Access, Crystal reports
General knowledge of and the ability to learn/regularly use various billing systems, EMR's and interfaces
Previous experience with various billing systems, such as Next Gen, Pro, Allscripts, Epic and others
Accounting skills preferred
Knowledge of CPT, ICD10 and modifiers.
Experience in specialties such as Psychiatry, Internal Medicine, Orthopedics, General Surgery
Familiar with HMO and IPAs, Medicare Fee for Service Plans and Commercial Payers
Strong communication skills
Working Arrangements
Standard work week or as defined by assignment requirements
Primarily works in standard office environment or remotely
May require after-hours, on-call support and/or holidays
On-call and after hours work during peak times including end of month/quarter/year; during this time PTO is limited to meet business needs
Track clients AR productivity and health (charge, payments, collections, adjustments) on a daily, weekly and/or monthly basis; as needed to ensure the client and company expectations are met
Remain current with company's policies and procedures regarding AR activity such as, reviewing month end reports to insure the AR and cash collections are meeting agreed upon benchmarks, identifying trends, reviewing denial reports
Analyze reports to determine when, how and why decrease in clients AR; includes denials, unbilled, credit issues, holds; determine corrective actions and communicate with client and staff to resolve. Follow up to ensure actions are taken that achieve the results needed and/or determine other resolution needed
Review work performed by outside vendors for accuracy and production. Determine changes/improvement needed and works promptly and appropriate with applicable individuals to bring about such changes/improvement
Achieve goals set forth by management and compliance requirements
Follows, enforces and models adherence to all policies, procedures and processes

Benefits

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work. Through our generous benefits package with an emphasis on work/life balance, we give our employees the opportunity to allow their careers to flourish.

Quarterly Company-Wide Recharge Days
Peer-based incentive Cheer awards
Tuition Reimbursement Program

To know more about the benefits and culture at Veradigm, please visit the links mentioned below: -

https://veradigm.com/about-veradigm/careers/benefits/

https://veradigm.com/about-veradigm/careers/culture/

Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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RCM Manager