Description

Job Title

Revenue Operations Manager

Location

Fairbanks, AK, US

Organization Name

Health Services

Job Summary

Job Summary: Job incumbent plays a critical role in our organization’s revenue growth by overseeing and optimizing the operations of our electronic health record platforms. This involves bridging gaps between billing and Health Applications to ensure smooth and efficient processes are in place and set up all billing platforms to include provider enrollment with payers. Works on all areas to ensure that the Billing & Denial Manager has everything in place in order to focus on revenue opportunities. Guides, coordinates, and directs all functions, processes, and activities relating to the Revenue Cycle for Health Services. Incumbent reports to the Director of Revenue Cycle.

Adhere to the TCC Ch’eghwtsen’ model of service and guiding principle which requires providing timely and effective service along with the ability to interact with others in a way that inspires trust and demonstrates respect, compassion and empathy.

Essential Functions

Essential Functions: This list is ILLUSTRATIVE ONLY and is not a comprehensive listing of all functions and tasks performed by incumbent(s).

Representative Duties: Under the general supervision of the Director of Revenue Cycle, job incumbent:

1. Supervise Enrollment Representative staff and ensures accurate and timely enrollments for providers and facilities.

2. Will report to the Revenue Cycle Director, including but not limited to the following: status of all enrollments, implementations with electronic health records and clearinghouse set ups.

3. Actively seeks updates from Medicare and Medicaid and all commercial payers as to guideline or policy changes – aligning changes with the electronic health records.

4. Collaborates effectively with all Department Directors and Staff to maximize revenue opportunities and ensures compliance with all applicable billing standards.

5. Attends all required meetings as directed by Management and always represents TCC in a competent and professional manner.

6. Performs all phases of supervision for enrollment, in accordance with TCC policies and position responsibilities, including recruitment efforts, staff training, performance monitoring and evaluations, as well as disciplinary actions and terminations as needed.

7. Works with Billing & Denials Manager on policy recommendations relating to RCM staff and third-party vendors. Assures that proper guidelines, legal guidelines, federal and state rules are followed.

8. In conjunction with appropriate program director and/or billing manager, jointly develops enrollment procedures for new providers and facilities.

9. Through active participation in electronic health record optimization committees and other department meetings, represents interests and concerns of TCC Health Services Revenue Cycle.

10. Obtains relevant training as needed to maintain applicable skills and knowledge.

11. Assures enforcement of Privacy Act requirements in all Billing Office activities.

12. Develop and implement strategies to improve enrollment and electronic health record implementations that will reduce revenue leakage.

13. Prepares detailed presentation of systems and applications designs, pricing, and analysis for day-to-day operations as well as projects and expansion.

14. Provides research, assessment, and implementation of new technologies, hardware, and software to advance the applications and services rendered by the organization.

15. Creates and maintains detailed project plans, scope of work, and technical documentation within assigned areas.

16. Responsible for coordinating aspects of planning, system testing, design, development, implementation, maintenance, and evaluations of assigned systems.

17. Participate in the development and testing of new billing software and systems to improve revenue cycle efficiency, including providing feedback on software performance and suggesting enhancements.

Other Responsibilities:

1. Additional responsibilities as mutually agreed by Revenue Cycle Director.

2. Other job-related duties as assigned.

Minimum Qualifications

Minimum Qualifications:

1. Accounting or Business degree. May be substituted for by years of experience in health billing administration at the discretion of the hiring manager.

2. Five years of supervising experience.

3. Must pass background check pursuant to the State of Alaska background check and federal Indian Child Protection and Family Violence Prevention Act requirements.

Knowledge, Skills and Abilities:

1. Knowledge of Quality Improvement mechanisms and principles, with strong focus on electronic health record systems development and alignment, including cycles of improvement.

2. Knowledge of insurance claim processing and third part reimbursement.

3. Knowledge of state and federal regulations as they pertain to enrollment and billing processes and procedures.

4. Skill in effective and oral, written and interpersonal communication.

5. Skill in time management and project management.

6. Ability to work efficiently under pressure.

7. Ability to work independently and take initiative.

8. Ability to deal with constant changes and deal effectively with challenging situations.

9. Must be able to maintain strict confidentiality.

Supervision: This position supervises: Enrollment Representative

Supervision

Physical demands: Work is primarily sedentary, with long hours sitting in front of a computer terminal typing. Some travel will be required, both inside and outside the TCC service area. Extended hours may be required, when necessary. Incumbent must be able to work accurately and efficiently in a busy and sometimes stressful environment.

Summation

Summation: Incumbent is responsible for Enrollment Representative. Incumbents must have strong skills in communication and strong revenue cycle knowledge. Will work collaboratively within the revenue cycle providing recommendation, guidance for billing operations and ensuring alignment with Health Services Strategic Plan goals/objectives.

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