Revenue Cycle Manager

POSITION SUMMARY:
The Revenue Cycle Manager is an essential member of a high performing management team who oversees client account activities, clinician/provider privileging and credentialing functions. The manager ensures the organization is compliant with local, state, and federal standards, policies, and guidelines. Work collaboratively to create and maintain a culture of excellence and dedication to providing compassionate and high-quality care to the people we serve and the community.

EDUCATION AND EXPERIENCE:
• Bachelor’s degree or higher in business, healthcare administration or another related field. 
• At least two (2) years’ previous experience in a supervisory or management capacity required.

DUTIES & RESPONSIBILITIES:
• Oversee and optimize the end-to-end revenue cycle, including charge entry, coding, claims submission, payment posting, and collections.
• Develop, implement, and maintain revenue cycle policies and procedures
• Manage daily operations of the revenue cycle department to meet financial and operational goals
• Ensure accuracy and timeliness in account reconciliation, pre-collection, and post-collection processes
• Investigate and resolve billing and authorization issues across public and private payers.
• Maintain oversight of Service Activity Log processes to ensure regulatory compliance as well as state and federal guidelines. 
• Lead denial management efforts, including identification, analysis, and resolution of claim denials and rejections
• Implement strategies to reduce A/R days, improve collections, and enhance profitability
• Analyze payer contracts and reimbursement trends to optimize revenue
• Recommend and implement process improvements to reduce errors and improve outcomes
• Basic denial trend analysis and reporting
• Ensure adherence to HIPAA, payer requirements, and federal/state regulations
• Maintain up-to-date knowledge of payment reform and industry changes
• Oversee internal and external audits, including quarterly coding audits, and implement corrective actions
• Ensure provider documentation is completed accurately and within required timelines
• Hands-on problem-solver in all aspects of collecting and billing including but not limited to working with funding partners.
• Performs personnel functions such as hiring, training, terminating, and conducting employee evaluations and disciplinary actions, as necessary. 
• Ensure accuracy and integrity of patient billing information and internal records
• Responsible for updating and correcting authorization errors that prevent services from being billed.
• Monitors and maintains insurance contracts with all payers. 
• Ensures all providers are associated with each health plan contract and system is set up to accurately bill those health plans. 
• Stays abreast of payment reform changes and advises the administration team of these changes and provides recommendations for changes necessary. 
• Lead end-to-end provider credentialing and enrollment processes
• Ensure timely credentialing/privileging, re-credentialing, and payer enrollment of behavioral health employees and clinic locations. 
• Enroll, update and re-attest as necessary for all health plan enrollment activity, keeping a detailed listing of all providers and their status with each contracted health plan. 
• Establish and maintain compliant credentialing policies and workflows
• Serve as the primary contact for credentialing with health plans, auditors, and regulatory agencies
• Cooperates in any investigation related to personnel, licensing, accreditation, or other circumstances.
• Communicate in a professional manner with various Starfish Family Services team members, Detroit Wayne Integrated Health Network (DWIHN), health plans, and other entities. 
• Evaluate and initiate process improvement with clinical leadership to ensure efficient/effective day to day operations for responsible areas and stay current on any upcoming payer changes. 
• Provides reports and details to management team to carry out the necessary steps for a claim to be billable. 
• Training and educating management team on billing practices and revenue cycle processes.
• Serves as the primary contact and expert for insurance companies as well as building and executing reports that accurately depict important business metrics and departmental metrics.
• Actively seeks opportunities to improve financial outcomes, engaging revenue cycle team members in the process.
• Responsible for following up on DWIHN risk matrix data. Provide summary and reports to senior leadership team.
• Responsible for recommending changes to the senior director that would improve service delivery. 
• Support the CFO with financial reporting, audits, and cost reporting
• Enhance workflow and revenue outcomes by analyzing (clinical) operational implementations, events, and potentially extended service lines of care that may result in heightened reimbursement. 
• Tracking and updating clinical reports and ensuring timely and routine updates are provided by clinical services team members.
• Completion of reports from DWIHN to include but not limited disenrollment report and MCO report.
• Participates in continued professional development including research and program presentation activities.
• Attends local, county, state, and agency meetings and training courses as required.
• Performs other duties as assigned by senior management.

KNOWLEDGE, SKILLS, & ABILITIES:
• Knowledge of general accounting principles and medical terminology. 
• Knowledge and understanding of state and federal rules and regulations regarding confidentiality, compliance, release of information, Fair Debt Collection practices, and insurance regulations. 
• Knowledge of principles and techniques used in negotiation as applied to service contracts and equipment purchasing. 
• Effective organizational, planning and project management abilities. 
• Experience in financial and programmatic presentations. 
• Demonstrated creativity and flexibility. 
• Ability to operate in high-pressure situations. 
• Demonstrated innovative approach to problem resolution.
• Experience with credentialing/impaneling of providers/facility eligibility with payers highly preferred. 
• Knowledge of ICD-10 Codes, CPT Codes, HCPCS Codes, Revenue Codes, and Place of Service Codes. 
• Experience working in Behavioral Health EHR system(s). 
• Intermediate level experience working in Microsoft Suite applications. 
• Knowledge of community mental health treatment programs and their continuum of care.
• Knowledge of supervisory principles and practices including personnel and systems management.
• Ability to communicate effectively both orally and in writing.
• Ability to manage multiple priorities, functions independently, and demonstrate good follow through.
• Ability to work positively and productively as a member of a team of colleagues, supervisors, agency staff and collateral contacts.
• Ability and willingness to give and receive constructive feedback.
• Ability and desire for personal and professional growth and skill development.
• Must be culturally sensitive and competent in working in a multi-cultural environment. 
• Must demonstrate capacity for developing autonomy and leadership among employees. 
• Must demonstrate skills in working tactfully with others.
• Flexible in assumption of responsibilities.
• Must maintain ethical and professional standards.
• Ability and willingness to work with all members of the community regardless of race, age, gender and cultural or ethnic background.
• Ability to represent the agency in a professional manner.

LICENSING AND OTHER REQUIREMENTS:
• Must have a valid State of Michigan driver’s license and automobile insurance.

Starfish Family Services is an Equal Opportunity Employer 

EOE/M/F/D/V