Manager, Revenue Cycle & Coding

Location: Commerce Place 

Work Days: M - F 8-4:30  

Category: Professional and Management  

Department: Revenue Integrity  

Job Type: Full time  

Work Shift: Day 

Hours/Week: 40.00 

Union: No 

Union Name: Non Union

Working under the direction of the Sr. Director of Revenue Cycle Operations, the Manager, Revenue Cycle & Coding is responsible for proactively driving revenue cycle metrics along with being an innovator within the revenue cycle and professional and hospital coding teams. 

This position will assist in the design, implementation and monitoring of new processes and policies in support of the strategic and revenue goals for the organization. The role will also support the development of new system requirements - working with IT and the various systems and departments to ensure all day to day operations are operating accordingly. The position is also responsible for building and monitoring external vendor relationships as it relates to CHA Physician’s Organization (CHAPO) AR management and provider coding education – this includes maintaining the CHAPO practice management system and ensuring synchronicity with other related databases.

Key Responsibilities: 

• Monitors and reports key performance indicators for the various revenue cycle and coding teams and any external parties involved in any aspect of revenue cycle phases; communicates revenue cycle performance results to key stakeholders within the organization; and recommends modifications to key indicators while continually improving performance and overall revenue cycle results.

• Utilizes a full range of financial, analytical and statistical techniques to evaluate, analyze, and review revenue and operational performance for the staff and outstanding accounts receivable to ensure that CHAPO and CHA hospital A/R is worked in a timely manner and within Federal, State and payer guidelines. Identifies and resolves discrepancies. Serves as subject matter experts as it relates to role.

• Performs detailed analysis of data, verifying current interpretation of regulations as well as projecting the effects of proposed or changed regulations. Performs ‘what if’ scenarios and sensitivity analysis on the impact of changes in departmental activities or new programs as it relates to reimbursement. 

• Makes recommendations for adjustments or remedial measures related to financial trends, economic and business forecasts, and clinic performance. This includes but is not limited to fee schedule modeling, revenue enhancement initiatives, payer reimbursements and fee pricing.

• Collaborates all system builds for Epic.

• Responsible for oversight of Coding and Charge Capture staff.

• Responsible for coordinating provider training and audits with external audit partner

• Responsible for all revenue WQ’s within Epic, and timely resolution of coding and charge capture edits

Qualifications:

• Bachelor’s degree in healthcare finance or health information management or a closely related field required. Equivalent, relevant experience may be substituted for a degree. Master degree in finance or health finance or health information management preferred.

• Certified Professional Coder designation required (i.e. CPC) with a minimum of five years progressive professional coding experience in coding analysis and coding/billing compliance/risk assessments, multi-specialty expertise, application in a variety of practice models and sites of service, including teaching physician settings.

• Minimum of five years of previous related experience in a central billing operation, MSO or practice management related position with accountability for results. Minimum of three years as the person responsible for performance and results for areas of revenue oversight within a healthcare organization.

 
In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment.