Revenue Cycle Manager

Galveston County Health District

Texas City, TX, USA

Full time

Jul 27

This job is no longer accepting applications.

Coastal Health & Wellness is seeking a new Revenue Cycle Manager! We are excited to have YOU join our team of professionals.

This position is responsible for managing and coordinating billing and collections functions for Coastal Health & Wellness, Galveston Area Ambulance Authority and Public Health services related to the collection of medical services payments and reimbursements from patients, insurance carriers and guarantors.

We can offer you:

• Excellent benefits; including an Amazing retirement package, paid time off plans, FREE life insurance, FREE long-term disability, Affordable medical insurance, FREE parking and much, much more! 

• Team Oriented Environment

• Salary Rate: Based on experience

We want you to join our team of professionals and begin a long-term career with us!

If you meet the criteria listed below, please apply.

Required:

  • Bachelor’s degree in Finance, Business or related field
  • One (1) + year supervisory experience in medical billing, coding, and collections, along with a working knowledge of CPT and ICD-9 and HCPC coding and medical terminology is required. Certified Professional Coder preferred.
  • Three (3) + years supervisory experience as well as an overall understanding of managed care products (HMO, PPO, etc.), and insurance laws and regulations is preferred
  • Three (3) + years’ experience in healthcare setting performing billing and collection practices, including federal and state programs
  • Three (3) + years’ experience in insurance credentialing preferred.
  • Experience reviewing insurance contract documents, monitoring and communicating any recommendations and/or changes to the appropriate entity
  • Customer Service Oriented
  • Excellent Computer Skills MS Office and experience in accounting specific software
  • Must be willing and able to work evening and weekend hours if necessary
  • Must be in compliance with GCHD Immunizations policy
  • Must be in compliance with ICS training requirements
  • Must pass criminal background check and drug/alcohol screening.

An equivalent combination of education and work experience which appropriately demonstrates the knowledge, skills and abilities to perform the above described essential functions will be considered when hiring for this role. 

Traditional Duties:

  • Acts as the billing liaison with outside billing agencies to ensure that all charges are billed in a timely manner
  • Responsible for payment processing, collections and accounts receivable management, denial management, reporting of results and analysis, training and development relative to revenue cycle, analytics, and all other revenue cycle management activities
  • Management oversight of all business-related functions of the patient visit from point of entry to settlement of the patients’ accounts
  • Monitors aged accounts and verifies appropriate collection procedures are being followed
  • Works with contracted billing services to ensure that patient billing and coding, accounts receivable/collection, and third-party claim processing functions are performed according to established policies and procedures
  • Prepares reports, metrics and presentations regarding revenue cycle status, and develops, monitors and assesses business metrics in order to refine processes and improve efficiencies
  • Tracks and reports unbilled encounters on a weekly and monthly basis
  • Establishes internal goals and identifies external benchmarks, setting forth progress, adverse trends and appropriate recommendations or conclusions
  • Reconciliation of billing and collections, and coordinates efforts to facilitate reimbursement of funds to ensure prompt payment and that timely filing deadlines are met
  • Works with Business Director to provide information needed to review and prepare annual fee schedules
  • Responsible for monitoring and implementing regulations related to Medicare, Medicaid, private insurance, and other third-party billing, provides updates on contracted insurance agencies and billing and coding changes as they occur
  • Reviews and monitors contracts with Medicare, Medicaid, private insurance, and other organizations for reporting requirements and compliance
  • Develops, implements, and maintains revenue cycle standard operating procedures
  • Finds cost-effective and practical solutions to business issues, and identifies areas for potential cost savings
  • Assures that revenue cycle practices are consistent with the overall practices of the Health District
  • Investigates, seeks resolution, and reports outcome of all business-related patient complaints in accordance with applicable laws, policies and executive procedures

Credentialing

  • Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process with insurance companies.
  • Facilitates all aspects of the credentialing process, including but not limited to new contracts, re-credentialing and monitoring for medical/dental staff and allied health practitioners.
  • Responsible for the accuracy and integrity of the credentialing process and for ensuring the timeliness of credentialing/re-credentialing verification.
  • Obtains appropriate licensure and/or certifications as required and maintains in appropriate database.
  • Ensures that insurance contracts are updated due to changes in staffing or other requirements.
  • Gathers confidential healthcare provider information and follows up with facilities to obtain documentation relevant to the credentialing process.
  • Maintains confidentiality of all business/work and medical and dental staff information.
  • Enrolls medical staff and other allied health professionals into provider networks.
  •  
  • Insurance Contracting
  • Facilitates relationships with health insurance companies to provide required documentation needed in the application and contracting process for existing and potential new lines of business.
  • Reviews potential contracts and submits to the Business Director/Chief Compliance Officer for review.
  • Works with the Chief Compliance Officer and CHW Business Director to negotiate contract language for new insurance lines of business.
  • Monitors new and existing provider networks for potential enrollment and expansion
  • Serves as primary point of contact for health insurances companies.
  • Defines third party payor benefits per contract if questions arise regarding coverage.
  • Maintains listing of current insurance contracts and communicates changes to Executive management.
  •  
  • Other Duties
  • Acts as liaison for the 1115 Waiver project, including but not limited to preparing quarterly reports; compiling information for audits; and attending meetings and training.
  • Run monthly exclusion reports
  • Compiles monthly, quarterly, and/or annual reports as requested.
  • Provides backup support to CHW Billing when necessary.
  • Performs other duties as assigned by supervisor

To apply please visit our website http://www.gchd.org/about-us/career-opportunities and fill out our online application. Applications can be submitted by fax to (409) 938-2284, emailed to apply@gchd.org or in person at 9850-A, Suite A-111, Emmett F. Lowry Expressway, Texas City, TX 77591.

No Phone Calls Please

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Galveston County Health District

The Galveston County Health District operates a variety of public health services and two FQHC clinics.

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