Prochant - Senior Manager - Revenue Cycle Management (12-15 yrs)

- The Senior Manager of Revenue Cycle Management (RCM) will be responsible for the overall performance and strategic direction of the revenue cycle for our clients.

- This role requires a highly experienced and results-oriented individual with a deep understanding of healthcare reimbursement, coding, denials management, and team leadership.

- The Senior Manager will lead a team of RCM professionals and will be accountable for optimizing the revenue cycle, improving key performance indicators, and ensuring compliance with all relevant regulations.

Responsibilities:

Leadership & Team Management:

- Lead, mentor, and develop a high-performing RCM team.

- Set clear performance expectations and provide regular feedback and coaching.

- Foster a positive and collaborative team environment.

- Conduct performance reviews and identify training needs.

- Effectively delegate tasks and responsibilities.

Revenue Cycle Management Oversight:

- Oversee all aspects of the revenue cycle, including billing, coding, claims submission, payment posting, denial management, and collections.

- Develop and implement strategies to optimize the revenue cycle and improve key performance indicators (KPIs) such as days sales outstanding (DSO), clean claim rate, and denial rate.

- Monitor and analyze RCM performance metrics and identify areas for improvement.

- Implement best practices for revenue cycle management.

- Ensure compliance with all applicable regulations and payer requirements.

Denials Management:

- Develop and implement a robust denials management program.

- Analyze denial trends and identify root causes.

- Implement corrective actions to prevent future denials.

- Oversee the appeals process for denied claims.

Medical Coding:

- Oversee the medical coding process to ensure accuracy and compliance.

- Stay up-to-date on coding guidelines and regulations.

- Collaborate with coding staff to resolve coding issues.

Managed Care:

- Manage relationships with managed care organizations.

- Negotiate contracts and reimbursement rates.

- Monitor payer performance and identify trends.

Practice Management:

- Collaborate with practice management teams to ensure seamless integration of RCM processes.

- Identify opportunities to improve efficiency and effectiveness of practice operations.

Reporting & Analysis:

- Prepare and present regular reports on RCM performance to senior management.

- Analyze data to identify trends and opportunities for improvement.

- Develop and implement action plans to address identified issues.

Process Improvement:

- Continuously evaluate and improve RCM processes.

- Identify and implement automation opportunities.

- Stay up-to-date on industry best practices and emerging technologies.

Qualifications:

- Bachelor's/ master's degree in Healthcare Administration, Business Administration, or a related field.

- Minimum of 12+ years of experience in medical billing, collections, and business process outsourcing within the healthcare industry.

- Minimum of 5 years of experience in a leadership or management role overseeing RCM operations.

- Proven track record of success in optimizing revenue cycle performance.