Network Revenue Cycle Manager

The Iowa Primary Care Association is in search of a Network Revenue Cycle Manager for our team in Des Moines, IA. 

PURPOSE OF POSITION

The Network Revenue Cycle Manager will report to the Director of Legal & Regulatory Affairs and will support member centers through developing and providing training and technical assistance for revenue cycle management activities from pre-appointment (registration, eligibility, etc.), during appointment (coding, charge capture) and post-appointment (billing, claims submission, A/R, collections, reimbursement, denials.) This position will build relationships with diverse health center staff and provide support and training to those staff critical to the revenue cycle management process including front desk operations, billing & coding, payer relationships and credentialing, and finance to ensure that our network health centers’ revenue cycle is efficient and effective. Ideal candidate will be an innovative, self-starter capable of working independently, making decisions and driving results.  Occasional travel around the state is required.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

The following duties are normal for this position.  These are not to be construed as exclusive or all inclusive.  Other duties may be required and assigned.

  • Organize and lead revenue cycle training and technical assistance to health centers, including development and presentation of training materials for best practices, compliance, etc.
  • Independently lead Front Desk Manager and Billing Manager work groups.  Plan and facilitate monthly webinars and semi-annual face to face meetings for each work group on prioritized RCM topics.
  • Works in a consultative role training health center staff, including providers and clinical staff, on payer specific (Medicaid, Medicare, Commercial insurance) policies and coding guidelines and best practices.  Must emphasize building those relationships.
  • This position does not do direct billing, but rather helps center billers optimize operations and implement new regulations or establish best practices.
  • Perform statewide revenue cycle key performance indicator (KPI) benchmarking including gathering, summarizing, analyzing and reporting data.
  • Independently make decisions on how to gather, summarize and track health center Medicaid Managed Care accounts receivable, reimbursement data, and billing/claims issues to analyze payment trends for escalation to Iowa Medicaid staff and Iowa PCA leadership.  Willing to innovate.
  • Research health center reported billing/claims issues to determine root cause and pervasiveness/impact across the network.  Work with payers to develop and deploy a fix and ensure adequate training and communication and drive to resolution.
  • Serve as liaison for Iowa PCA network members with Iowa Medicaid and the Medicaid Managed Care Organizations to ensure communication and understanding of program requirements and changes with our health centers.
  • Serve as subject matter expert on Federally Qualified Health Center (FQHC) reimbursement for both Iowa Medicaid and Medicare, including the PPS, wrap, cost reporting and cost settlement processes, including implementation of alternative payment methodology.
  • Serve as expert and provide training to health center staff and clinicians on various payer specific coverage requirements, including prior authorizations, referrals, etc.
  • Serve as billing/coding subject matter expert for pay for coordination and other payor population health management programs to ensure program compliance for reimbursement. Examples of these programs include MIPS, Medicaid Chronic Condition Health Home and Integrated Health Home programs and the Medicare Chronic Condition Management program, Annual Wellness Visits, and Behavioral Health Integration opportunities.
  • Proactively work with health center Finance leadership to develop and implement RCM performance improvement projects with member centers to achieve health center and network RCM goals.
  • Work with the Transformation and the Analytics Teams on innovative performance improvement projects to understand and implement opportunities for enhanced coding for accurate risk capture and reimbursement maximization.
  • Collaborate with Iowa PCA Help Desk staff and vendor on tickets related to the Centricity/Visualutions Practice Management system that require expert knowledge of RCM or payor processes.
  • Manage and develop a high degree of expertise in revenue cycle operations, technical processes, and financial reports (UDS, VIS, etc.), as well as understanding the measures as new programs are rolled out.

 SUPERVISORY RESPONSIBILITIES

This job does not have supervisory responsibilities.

 

QUALIFICATIONS 

The successful candidate will have a Bachelor's in business administration, healthcare administration / management or a related healthcare field, along with 5 to 7 years of revenue cycle management experience.

  • Current CPC, CFPC, CRC or other billing/coding certification required.
  • Thorough working knowledge of CPT and ICD-10 coding protocols and procedures.
  • Proven experience with performance improvement methodologies (LEAN, Six Sigma, PDSA), etc. and responsibility for application within a clinical setting required.
  • Builds relationships with diverse partners.  Sociable.
  • Ability to work independently in a consultative capacity while leveraging/influencing others to achieve goals.  Results-oriented.
  • Ability to independently create and present training to others.
  • Thrives off new challenges, variety and flexibility to work independently and empowered to make decisions.
  • Excellent written and oral communication skills with the ability to provide clear, concise directives.
  • Experience with setup, management, and maintenance of at least one Practice Management software preferred.
  • Well-versed with all federal, state and HIPAA privacy regulations.
  • Knowledge of medical necessity rules and procedures impacting claim submission, denials and insurance reimbursement.
  • Ability to manage, work and deliver results on multiple projects at the same time.
  • Knowledge of FQHC regulatory requirements, health care delivery standards, policies and procedures is strongly preferred.

Language Skills:

Ability to read and interpret documents and operating and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups.

 

Mathematical Skills:

Ability to calculate figures and amounts such as discounts, interest, proportions, percentages, area, circumference, and volume.  Ability to apply concepts of basic algebra and geometry.

 

Reasoning Ability:

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.  Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

 

Computer Skills:

To perform this job successfully, an individual should have knowledge of Microsoft Office programs, including spreadsheets, word processing, and databases. Knowledge of the setup and maintenance of Practice Management software required. Centricity and NextGen preferred.

 

To Apply, Click Submit Your Resume. 

Additional Info

  • Specialty: Iowa Primary Care Association
  • Position Type: Full Time
  • Location: Urbandale

Submit Your Resume