Responsible for developing and implementing all financial, service level agreements, key process performance KPI’s and ad hoc reporting for Revenue Cycle Management (RCM) organization (~150 employees). Role requires using the developed reports to provide recommended areas of improvement areas across LMS. Role will also lead achievements and deliverables of NGAE/HDMS project (~2 yr project) relating to RCM, primarily focused on data architecture and working with functional managers to optimally transition to new systems environment while phasing out old systems with minimal disruption or negative business impact.
DUTIES AND RESPONSIBILITIES:
Responsible for all aspects of daily, weekly, monthly, quarterly, annual RCM reporting aspects
Identifies through analysis and makes recommendations for opportunities in each area of RCM that align with annual objectives for Liberator Medical and Home Care.
Acts as project lead for RCM on transition to HDMS and Salesforce.com
Responsible for all database elements that impact revenue in legacy and new systems
Works collaboratively across LMS Operations, Finance, Home Care BI and IT to validate RCM data that is demonstrated by all end users.
Aligns with functional managers and team leads on key process development and associated monitoring tools to ensure company policy, quality of claims and other compliance aspects are maintained
KNOWLEDGE AND SKILLS:
Knowledge and experience with medical billing and electronic workflow software.
Understanding the claim submission process and ability to verify transmission of electronic claims
Proven experience in reviewing and appealing insurance denials.
Knowledge of standard healthcare remark and reason codes driving denials
Self-starter with financial and problem solving acumen, along with critical thinking and analytical skills
Proven experience developing and implementing new processes and continuous improvement initiatives, and improving upon department metrics.
Excellent written and oral communication skills with the ability to provide clear, concise directives, with professional diplomacy and positive outcomes. Writing skills to include the ability to effectively provide SOP’s for the various aspects of the revenue cycle including efficient A/R management.
Strong leadership skills – ability to lead and serve as an effective team member in a large organization including planning, developing, organizing, directing, managing, and evaluating personnel.
Detail oriented and organizational skills, and proven track record to effect positive change.
Ability to foster and maintain relationships with department heads and staff, vendors, payers and healthcare providers/clients.
Sophisticated analytical reasoning to include ability to forecast exponentials within work flow processes and reason against outside factors
Bachelor of Administration or MBA preferred but not required
Minimum 3 years’ experience in Medical Billing, particularly with DMEPOS, Medicare Part B
SQL, Tableau, Power BI, Salesforce.com, Fastrack, Waystar or other large database software or BI solutions, preferred
Super user of Microsoft Office Applications