We are looking for a manager for our Revenue Cycle Management (RCM) team. This person will provide leadership and support to senior management and physicians while evaluating and continually looking for improvements and efficiencies in the revenue cycle. This role is well suited for an individual with proven operational, reporting and compliance background in RCM, and capable of building an RCM team and internal infrastructure. Must be a hands-on, self-starter comfortable in an entrepreneurial environment. This position will report to the Chief Financial Officer.
The Revenue Cycle Manager will have the opportunity to develop and implement the RCM infrastructure to launch Dermatology within Sona. RCM is responsible for promoting the financial viability of Sona by effectively managing all aspects of the organization’s revenue cycle operations. Including overall direction to identify issues, monitor performance, and assists in problem resolution. Acts as a liaison between external billing vendors, internal departments and physicians to ensure accurate and timely charge capture. Manages staff to meet department's overall cash targets, account receivable goals, and quality and productivity measures. Consistently monitors appropriate billing, and collections requirements to ensure maximum reimbursement. Creates a culture of compliance and ensures adherence to all federal and state regulations.
ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):
Works with external billing company and supervises internal billing liaisons to ensure efficient revenue cycle operations.
Conducts regular RCM staff meetings to disseminate and discuss information concerning unit workflow, processes, challenges, successes, goals and solutions.
Leads monthly meetings with operations managers and physicians to review key metrics, trends and performance improvement opportunities (staff training, provider coordination, policy/process revisions, etc.)
Communicates changes and process improvement opportunities to the Corporate Support team and Operations team in a timely manner.
Creates a positive work environment and encourages employee feedback and collaboration.
Collaborates to develop and implement policies and procedures related to all aspects of the revenue cycle process including: registration, authorization/insurance verification, charge capture, coding, reconciliation, payor contract performance, point of service collection, and training.
Write and maintain process documentation which clearly specifies workflows, roles and responsibilities required to carry out the goals of the department.
Responsible for claim submission and processing, payment processing, collections, accounts receivable management, and denial management.
Review audits of tasks and work for accuracy of data entry and provide feedback to practice managers and front office staff in a timely and constructive manner.
Develops and implements systems and business controls to monitor staff operational compliance; ensures staff are operating under all applicable standards and following policies and procedures.
Monitors the financial success of insurance and self-pay billings and collections by ensuring guidelines are appropriately documented and performed; and ensures that established policies and procedures are followed to ensure maximization of revenues for new programs and services.
Identifies process improvement opportunities to reduce denials and maximize cash collections.
Maintain practice management system tables such as charge master, fee schedules, and claim rules.
Regulatory and Compliance Monitoring
Work with Compliance Officer to develop and monitor compliance with policies and procedures for revenue cycle management.
Assist with the development and management of a provider compliance program around coding and billing.
Oversite and management of government mandates regarding payment and quality improvement programs; inclusive of rollout, monitoring, and feedback for end-users.
Assists with the implementation of regulatory and quality standards as they relate to or impact the overall functioning of revenue cycle programs.
Reporting & Analysis
Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement in a variety of areas, including but not limited to: coding, claim submission, insurance and self-pay collections, refunds and write-off approvals.
Design, develop and configure customized dashboard solutions using the analytics toolset.
Develop monthly reporting and audit procedures for physicians and front desk.
Establishes appropriate and industry standard financial benchmarks for staff. Develops utilization and productivity standards; develops systems to improve and provide in depth financial analysis of operations; and provides financial spreadsheets and reports determining the feasibility of a new initiatives.
Provide routine reporting of Key metrics include: AR days, cash collections, denials, avoidable write-offs, refunds, charge lag, bad debt, etc.
Verifies that fee schedules are appropriate against insurance payors, allowable fees, and expected reimbursement calculations are current accurately stated.
Monitor and evaluate third-party bad debt collections efforts, as well as early-out opportunities.
Coordinates with accounting to ensure accurate and timely month-end financial reports.
Bachelor’s Degree in Business, Healthcare, or related discipline OR equivalent of education and experience required.
5 years medical practice or health system revenue cycle experience required.
2 years experience managing, delegating, and following up on work priorities of others is strongly desired.
Well versed in CPT and ICD10 codes and procedural modifiers, claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
Extensive knowledge and experience in revenue cycle operations for multi-million-dollar receivables management.
Knowledge and experience in payer contracting and payment mechanisms.
Knowledge of medical practice management and EHR software and systems. Preferably Athena (practice management system) and EMA/Modernizing Medicine (EHR system).
Ability to communicate effectively both orally and in writing; and present information and respond to questions from groups of physicians, managers, and the public.
Leadership skills to hire and train employees, appraise work performance, address employee relations issues, and resolve problems.
Demonstrated proficiency in situational and change leadership, effective fiscal management, resource allocation, strategy and planning within a dynamic environment
30% travel expectation.
Internal Number: 007
About Sona Dermatology & MedSpa
At Sona Dermatology & MedSpa, you’ll find exceptional patient-centric care with a comprehensive offering of medical and cosmetic services. Our goal is to provide you high quality skin care using leading edge technology and medical expertise – all in a warm, welcoming environment. We’re redefining the doctor’s office visit to start you on your lifetime journey toward optimal skin health and appearance.
Established in 1997, Sona’s founders quickly realized the potential and power of the cosmetic dermatology/medical spa concept – bringing medically supervised skin health treatments into a luxury spa environment with a passion for customer service.
To establish Sona Dermatology & MedSpa as the trusted global leader in the medical aesthetics industry by providing clients with affordable services, unsurpassed treatment efficacy and the highest regard for personal safety. Our inspiration comes not only from natural external beauty, but also from the beauty within.