The Revenue Cycle Manager is responsible for managing the organization's Clinic Revenue Cycle; which includes, but is not limited to: intake, scheduling, registration, billing and coding denial/appeal management and referral/authorization management; while ensuring our organization remains in compliance with FQHC standards and procedures. It is important to note that the direct responsibilities will include a subset of these areas, this position is the primary contact/lead for DAP's Patient Clinic Practice Management.
Job Type: Full time
FLSA Status: Exempt
Reports to: Chief Financial Officer
Oversee the administrative functions of the Clinic revenue cycle. This includes, but is not limited to: intake/registration, scheduling, referrals, medical provider coding, eligibility authorization, billing and denial management;
Manage the compliance billing and collection practices of DAP;
Provide support for clinical/referral staff in determining appropriate CPT & ICD coding
Manage and negotiate Medical Insurance Contracts, (including capitation activity);
Manage relationships, disputes, denials, grievance and payor audits
Ensures highest degree of billing and collection compliance.
Manage and oversees Fee-schedules and sliding-fee-scales;
Manage billing and collection policies and procedures;
Responsible for all aspects of departmental operations, staff management and for creating a positive professional work environment;
Manage Outsourced Vendor (Billing) organization to ensure efficient and effective billing and collection processes;
Evaluate staff performance, develop staff and management skills, establish goals and objectives, and performs ongoing evaluation of departmental operations to ensure maximum efficiency and effectiveness;
Manage operating budgets for assigned areas. Prepares departmental financial, operating and performance variance reports;
Work with Patient Access, HIM, IT, EHR, Clinical and other departments to ensure compliance with all supporting documentation necessary for successful claims submission and reimbursement;
Maintains billing/operational proficiency to identify areas to ensure DAP is optimizing Revenue Cycle opportunities;
Routinely evaluate and manage Clinic Receivable balances.
Required Education and Experience
BA/BS Degree in Finance, Accounting, Business or related area;
Minimum seven years supervisory experience;
Must have Patient Financial Services/Business Office experience with Medicare, Medicaid and Commercial Insurance;
Demonstrated knowledge (minimum of seven years) of clinic professional coding, billing, collecting and monitoring billing practices and required administrative controls, laws, and terminology;
Working with a FQHC facility including FQHC billing and collection, MediCare/MediCAL Cost Report/PPS Reconciliation;
Demonstrate understanding of clinic operations and business practices;
Progressive Revenue Cycle experience - 7 years;
Must be a hands-on manager and leader with a focus on performance.
Preferred Education and Experience
Certified Coding Certification;
Strong analytical skills to review patient accounts
Excellent internal/external communication skills needed to interact with other clinics, departmental staff, representatives from regulatory agencies, payors, other clinic staff, patients and administration;
Demonstrated knowledge and application of CPT, HCPCS and ICD-10 coding systems, electronic claim filing;
Demonstrated knowledge of FQHC reimbursements, billing, cost and UDS reporting, and reconciliations for Medi-Cal wrap billing;
Computer proficiency in MS Word, Excel, and Outlook.
Internal Number: DAP1802
About Desert AIDS Project
Who we are—from humble beginnings
Founded in 1984 by a group of community volunteers in the face of the AIDS crisis, Desert AIDS Project (D.A.P.) has been the Coachella Valley’s primary not-for-profit resource for those living with, affected by, or at-risk for HIV or AIDS.
Today, we are a Federally Qualified Health Center (FQHC) with the goal of improving the overall health of our entire community, especially the disenfranchised. D.A.P. provides comprehensive, culturally competent, quality primary and preventative health care services including; primary medical care, HIV and Hepatitis specialty care, dentistry, behavioral health and social services all-under-one-roof.
We have never lost touch with our volunteer roots, nor our expertise and dedication to combating the AIDS/HIV epidemic. In fact, our donors and volunteers are essential to our growth and expanded capacity to meet the needs of those facing economic disadvantage. As D.A.P. continues to strive to become fiscally self-sustaining, we are so grateful to more than 400 volunteers who contribute over 60,000 hours of service annually – the equivalent of almost 30 full-time employees. In fact, two volunteers each worked 2...,000 hours in the last year alone! Our volunteers receive neither a paycheck nor other paid benefits.