Manager, Revenue Cycle Audits

Job Title: Manager, Revenue Cycle Audits

Position Summary:

The Revenue Cycle Audit Manager is responsible for building and maintaining collaborative and productive personnel audits within the organization and with outsourced billing providers related to Revenue Cycle Management (RCM). This role will manage revenue cycle audit projects related to personnel training, productivity, and accuracy to drive performance in operations related to reimbursement. The position provides direction and oversight of processes impacting cash collections and reports to the Senior Director of Billing and Clinical Information Management Strategy and/or the Associate Director of the Revenue Cycle Audit Team.

Job Responsibilities:

• Audits and Analysis:

  • Perform audits and analysis, identify trends, present opportunity areas, and prioritize initiatives for performance improvement for the revenue cycle team.
  • Build auditing templates with an effective scoring methodology to monitor RCM team performance in areas such as billing, coding, denial management, and patient billing.
  • Monitor and manage targets for personnel SLAs with internal and external teams via audits.
  • Serve as a source of knowledge for the revenue cycle team.

• Team Management:

  • Manage a team of auditors including hiring, training, and setting processes for personnel audits.
  • Track outcomes of personnel audits and training to ensure audit feedback is effective.

• Process Improvement:

  • Responsible for modifying workflows, SOPs, and SLA tracking for the designated revenue cycle function based on audit findings.
  • Work with other teams/departments to streamline and strengthen processes, including billing automation.

• Collaboration:

  • Establish an ongoing working relationship with other departments and external vendors impacting revenue cycle performance.
  • Work closely with various vendor operations teams (Prior Authorization, Claims, and Appeals) to oversee personnel activity that directly impacts the revenue cycle for optimal reimbursement.

• Reporting and Coordination:

  • Lead weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities and provide detailed status reports to management.
  • Coordinate with management to ensure a thorough understanding of trends/issues affecting revenue cycle performance.

• Performance Goals:

  • Develop performance goals and metrics to link department and revenue cycle initiatives with the organization's strategy.
  • Develop, manage, and monitor successful completion of implementation and project plans.

Qualifications:

• Bachelor’s degree in Accounting, Business, Healthcare related field, or equivalent experience.
• Minimum of 6-8 years of related experience in medical billing and/or insurance collections, including at least 3 years of experience with prior authorization requirements, AR & Denial management, payer utilization management policies, and appeals.
• Certified in coding or similar coding management experience.
• Lab & Diagnostic industry-based RCM experience would be a plus.
• Management experience is required.

Required Knowledge, Skills, and Abilities:

• Proficiency with medical billing systems, Microsoft Excel, medical terminology, and basic procedure coding knowledge.
• Knowledge of medical terminology and abbreviations, and healthcare nomenclature and systems.
• Ability to navigate across multiple customer demands and balance competing priorities successfully.
• Ability to analyze, identify, and articulate identified trends and report trends succinctly in a clear and concise manner.
• Strong communication skills.
• Demonstrated ability to work independently and collaborate with team members.
• Motivated to be creative and brainstorm innovative solutions.
• A desire to work for a dynamic and growing molecular genetics laboratory and manage growth for optimal success.

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