Manager of Revenue Cycle Management

Position Summary: The Manager of Revenue Cycle Management is a high-impact, key member of the Florida Community Health Centers, Inc.(“FCHC”) leadership team, responsible for overseeing all patient service and pharmacy revenue including coordinating and reporting on all aspects of payer billing & collections. The Billing Analysts and Medical Coder report into this position, with matrix reporting from the Senior Accountant (Revenue) and close collaboration with the Director of Finance (Controller). Works closely with Credentialing and HR department staM responsible for provider/clinician credentialing who maintain the Epic Provider Enrollment table as current. This position also collaborates with leaders across the organization in Clinical, Quality, Pharmacy, Operations, HR and Strategic Initiative areas

Roles and Responsibilities:

RCM Systems Oversight & Administration

• Monitor and report on the performance of Epic, Rx30 and other peripheral electronic medical record and billing systems.
• Design and communicate billing & Epic Professional Billing (‘PB”) “rules” to Health Choice Network (“HCN”) on regularly scheduled and attended meetings.
• Regularly monitor volume of prescriptions transmitted to contract 340bThird Party Administrators (“TPAs”), noting any significant changes in volume or margin (net recovery) from those transactions
• Support FCHC’s CFO in reviewing the financial impact of all changes to the organization’s charge master in Epic, Rx30 or peripheral systems.
• Work closely with Finance Dept leadership on ensuring EOB and payment posting activities reported in the central clearinghouse reconciles to FCHC’s general ledger (Great Plains Dynamics) and to ensure all RCM activities are recorded correctly and accurately.
• Advises the Manager of Payor Relations & Credentialing of all denials where reason codes state providers were not properly credentialed and/or providers do not have the appropriate taxonomy or place of service recorded in their claim systems
• Maintain all changes to and coordinate updates to FCHC’s Billing & Collections and Sliding Fee Discount Program (“SFDP”) Administration policies.
• Meet periodically with HCN Assoc. Director, Integration & Patient Experience and the Labcorp Business Development Executive, Value-Based Care to ensure reference laboratory activity and associated billing to FCHC is meeting stated performance and contract standards.
• Build and support Financial Estimate templates in Epic as a way to improve the accuracy of patient collections at the health centers.
• Support FCHC’s Director of Finance (Controller) and CFO in the process of administration over all HRSA-required policies that impact patient Billing, Collections, the SFDP compliance areas
• Advises other leaders on RCM as it pertains to new services or services not already included inside the Epic environment

RCM Leadership & Staff Development

• Directly supervise team of Epic Billing Analysts
• Oversee formal Epic “actions” taken by the Billing Analysts including but not limited to post-billing write-offs, appeals and escalations.
• Along with the Director of Operations, host weekly “Denials Management” calls with health center leadership to assist in their Epic workqueue efforts (specifically to increase the rate of “clean claims” generated)
• Develop “micro-learning” training sessions for target denials management areas
• Collaborate with the Director of Finance (Controller) on the development of a monthly RCM variance analysis and other reporting to be included in senior leadership and Board-committee level reporting
• Maintain and report on RCM training curricula and/or guidance provided to various user-groups as part of a comprehensive strategy for increasing awareness of RCM best practices and improving the overall recovery of claims

Payer Relations: Contracts & Claims Management

• Establish relationships with payer (claims) representatives, schedule and conduct regular meetings to review trends in denials, collections expectations, status of provider credentialing/linkages, and Epic payor scorecard results
• Analyze contract variances by service line, make recommendations for changes to Epic billing rules, payer fee schedules in Epic, FCHC chargemaster rates, timing and method for payer rate negotiations
• Collaborate with the Chief of Strategic Initiatives and Manager of Payor Relations & Credentialing on contract and fee trends prior to each payer meeting
• Lead all eMorts tied to payer “escalations” (where payers will have to run claims impact reports prior to paying FCHC for previously denied claims)
• Monitor the performance of all “Special Contracts” (non-payer agreements with community partners) including but not limited to analyzing net realization of associated services and administrative eMorts needed to support the contracted activities.
• Contribute to a tactical workplan designed to further FCHC’s readiness to participate in more robust risk-based contracts

Medical Coding: Epic Rules & CDI Optimization

• Collaborate with the FCHC’s Regional Medical Directors and Medical Coder on the development of Epic coding “rules” (or smart lists, macros, other methods of automation) that will result in improved clinical documentation across all department specialties
• Support FCHC’s Medical Coder in the process of addressing HCC coding work queues, identifying trends and potential clinical documentation barriers to optimizing patient risk scores
• Along with FCHC’s Regional Medical Directors and Medical Coder, establish an annual clinician coding communication plan, highlighting what content is to be included in the monthly Clinician Connections newsletter.

Organizational Reporting and RCM Risk Management

• Draft and distribute weekly “RCM Briefings” which highlight key trends in RCM and Operations that impact patient service and pharmacy revenue
• Draft and distribute monthly Epic “Denials Analysis” report, highlighting significant trends in preventable denials and specifically identifying areas where focused efforts will improve net financial recovery
• Collaborate with the Director of Finance (Controller) and other Finance Department leaders by performing detailed reviews of Accounts Receivable (“AR”) to ensure FCHC reserves are adequate yet not excessive
• Draft and coordinate the performance of billing audit work programs, designed to address specific risks identified in FCHC’s reimbursement risk management domain
• Support FCHC’s CFO and Director of Finance (Controller) in the development of semi-annual budgets and forecasts (patient service and pharmacy revenue projections)
• Periodically compare components of FCHC’s overall denial rate with other FQHCs, including recommendations for increasing the overall rate of “clean claims”

Qualifications and Education Requirements

Minimum Requirements (experience, training, and education): To effectively fulfill this position, candidate must meet the following requirements:

• Minimum of five (5) years’ experience working in revenue cycle management, ideally in an Epic EMR environment
• Bachelor of Science or Bachelor of Arts degree in applicable course work and applicable work experience. Master’s level degree and some business law experience preferred.
• CPC certification and specific knowledge of Medicaid and Medicare billing or other regulatory guidelines applicable to federally-qualified-health centers preferred.
• Must demonstrate advanced knowledge of systems administration, best practices in RCM in ambulatory settings, payer credentialing, contracting, payer appeals and escalation activities
• Exceptional communication, training and staff development skills.

This job description is not intended to be all-inclusive, and employee will also perform other reasonable related business duties as assigned by supervisor.

* This organization reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment*.