Revenue Cycle Manager Job in Madison, Wisconsin

Summary of Major Responsibilities

The Manager, Revenue Cycle is responsible for leading the team and driving the strategies of the entire revenue cycle process of a clinical independent lab with integrity and quality. This position requires an extensive understanding of and experience with the medical billing process, Medicare compliance, payer audits, and the independent lab industry and personnel The Manager, Revenue Cycle is responsible for communicating the health of the department to leadership teams via meetings, conference calls, presentations and reports. The role also requires strong skills and experience in personnel management, leading and building teams to foster a culture grounded by the core values of integrity, teamwork, innovation, and quality

Essential Duties and Responsibilities

• Develops and maintains all revenue cycle department’s priorities, procedures, and policies for Exact Sciences.
• Determine appropriate and effective performance metrics and staff requirements for the department to run with efficiency and accuracy while providing outstanding customer service.
• Develops processes and procedures for the efficient and successful flow of interdependent information between the third-party billing vendor, the receivables department and Exact Sciences contact center.
• Designs and execute key strategies and infrastructures to drive collection of earned reimbursement for lab operations.
• Develops processes and policies for exception handling, appeals and denials and balance billing.
• Monitors all client accounts receivable activity and performance and initiates appropriate corrective measures as needed.
• Investigates denial sources, trends, resolves and appeals with cross-functional team involvement.
• Monitors billing compliance with all third-party payer regulations.
• Ensures that customer satisfaction, via all personnel, is achieved through courteous and effective communication, problem solving and efficient processes.
• Oversees and manages the daily performance of the revenue cycle department and all accounts receivable operations.
• Motivates team on month end goals and metrics. Reports on month end activity to key leadership.
• Promotes and demonstrates a team-oriented environment that fosters effective collaboration within and outside of the department.
• Monitors all departmental processes to ensure compliance with performance metrics and relays this to leadership in a timely, effective manner.
• Hires, coaches, inspires and motivates team; Implements and monitors staff productivity and service performance metrics and reports this to leadership.
• Maintains confidentiality in compliance with HIPAA regulations and ensures that department remains compliant with all relevant regulations.
• Implements and assists with innovative staff education programs.
• Supervise staff including but not limited to organize and prioritize work, write/conduct performance reviews, train/develop, and manage work performance.
• Apply deep familiarity with payer/insurance appeals and reimbursement processes, experience working in the insurance industry and professional billing.
• Apply knowledge and familiarization with the Medicare billing regulations, compliance, and reimbursement methodologies especially in the laboratory environment.
• Apply knowledge of third-party billing service provider (i.e. Xifin, Epic) or revenue cycle management software and outsourced billing organizations.
• Apply strong analytical and forecasting skills with demonstrated ability to plan workload, allocate tasks and scale operations to align with business priorities.
• Oversees and implements staff reporting and building key productivity and accuracy metrics.
• Apply strong organizational and problem-solving skills.
• Apply adaptable, open to change and able to work in ambiguous situations and respond to new information and unexpected circumstances.
• Utilize strong interpersonal and teamwork skills including the ability to easily convey concepts and priorities as well as ability to solicit feedback and inputs.
• Utilize strong presentation skills with ability to convey information and adjust delivery as appropriate to the audience.
• Ability to inspire and motivate others and work effectively through influence and collaboration.
• Support and comply with the company’s Quality Management System policies and procedures.
• Regular and reliable attendance.
• Ability to work normal schedule of Monday through Friday during normal business hours.
• Ability to work in front of a computer screen and/or perform typing for approximately 80% of a typical working day.

Minimum Qualifications

• Bachelor’s degree in healthcare administration, business or related field; or high school degree/general education diploma and 4 years of relevant experience in lieu of degree.
• 8+ years of experience working in the medical/healthcare billing area, with strong, demonstrated knowledge of managing claims processing.
• 5+ years of leadership experience with demonstrated ability to recruit, assess, motivate & inspire others to help business achieve success.
• Authorization to work in the United States without sponsorship.
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation

Preferred Qualifications

• Leadership in accounts receivable or billing operations.
• Experience working in both payer billing and provider billing operations in a laboratory.
• CPC, CPM, CPCO, CPMA or similar certification.
• Membership in any of the patient accounting organizations (i.e. AHAM)