Job Description

Job Purpose: Responsible for managing the operations of Appeals, Payment Posting, Collections, and Financial Counseling teams. Ensures adherence to established Standard Operating Procedures (SOPs) and achievement of Key Performance Indicators (KPIs) to maintain revenue cycle efficiency. Works collaboratively with leadership to keep Accounts Receivable (A/R) within organizational targets and provides technical oversight for billing and appeals processes across all payers and identifies variances to goals and RCM trends.

PRIMARY DUTIES INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING· Revenue Cycle Oversight: Direct submission of claims and appeals for denied claims, ensuring compliance with SOPs.· KPI Monitoring: Maintain performance metrics such as:o Days in A/R within target range.o Clean Claim Rateo Denial Rateo Appeals Resolution Turnaround· Workflow Management: Organize daily operations to minimize backlog and optimize productivity.· Staff Leadership: Interview, hire, evaluate, discipline, and coach employees. Conduct regular team meetings for communication and accountability.· Compliance & Education: Stay current on payer regulations, coding updates, and appeal trends. Train staff to ensure adherence to SOPs and compliance standards.· Reporting: Provide monthly KPI dashboards and production reports to leadership.· Continuous Improvement: Identify process gaps and implement improvements to enhance efficiency and reduce risk.

Requirements

OTHER JOB REQUIREMENTS

· Professional demeanor, customer-focused approach, and ability to foster teamwork.

· Commitment to ongoing education and compliance with federal, state, and local regulations.

· Proficiency in Athena EMR systems and Microsoft Office Suite.

SUPERVISION Reports to Revenue Cycle Director

MINIMUM QUALIFICATIONS

EducationRequires a high school diploma or GED; bachelor’s degree in healthcare administration or related field preferred.

Experience

· Minimum 5 years of experience in revenue cycle management (RCM) and 3 years in leadership or management role. Strong background in pain management preferred.

· CPC certified or 3 years of coding experience.

· Experience with Athena preferred.

WORKING CONDITIONS

Environmental ConditionsMedical Office environment

Physical Conditions

· Must be able to work as scheduled – typically from 8:00 – 5:00 M-F

· Must be able to sit and/or stand for prolonged periods of time

· Must be able to bend, stoop and stretch

· Must be able to lift and move boxes and other items weighing up to 30 pounds.

· Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.

KNOWLEDGE, SKILLS AND ABILITIES

· Clear and precise communication

· Knowledge of medical terminology, CPT, ICD-9 & 10 coding, collections for ambulatory surgeries, anesthesia and in-office procedures

· Knowledge of correct billing techniques, forecasting and the billing revenue cycle

· Effectively manages day by organizing and prioritizing

· Applies tactful principles and practices of dealing with the public

· Protects patient information and maintains confidentiality

· Familiarity with EMR systems and skilled in using Microsoft Office Suite

· Ability to work under pressure

· Ability to hire, manage and discipline staff appropriately