Job Description

Medusind is a leading provider of revenue cycle management solutions to dental, behavioral health, anesthesia, pathology, emergency, surgery, radiology, and other specialties. In January 2023, Alpine Investors, a people-driven private equity firm, invested in Medusind to continue to advance its leadership position as one of the top revenue cycle management companies in the country.

We are seeking an experienced and results-driven Revenue Cycle Management (RCM) Manager to oversee and optimize the revenue cycle processes within our organization. This pivotal role ensures that all aspects of billing, coding, claims submission, payment processing, and collection are efficiently managed and compliant with regulatory requirements. The RCM Manager will work closely with various departments, including finance, operations, and clinical teams, to ensure smooth and accurate revenue cycle operations, with a focus on maximizing reimbursement and minimizing delays.

Key Responsibilities:

Revenue Cycle Oversight:

• Oversee the end-to-end revenue cycle process, ensuring timely, accurate, and compliant billing and collection.
• Monitor accounts receivable (AR) trends, identify issues, and implement corrective actions to maintain healthy cash flow.
• Ensure all coding and billing procedures comply with payer contracts and government regulations.
• Supervise and mentor RCM staff, including billing, coding, and collections teams, to optimize their performance.

Billing & Coding Management:

• Ensure that claims are accurately coded and comply with payer requirements and industry standards.
• Coordinate with healthcare providers, clinicians, and coding teams to ensure that clinical documentation is complete and accurate.
• Resolve discrepancies in coding or billing to prevent claim denials and rejections.

Claims Management:

• Oversee the submission of clean claims to insurance providers, ensuring the process is efficient and that no claims are delayed.
• Review rejected or denied claims and implement strategies for timely resubmission, appeal processes, and follow-up.
• Analyze claim denial trends and work with relevant teams to resolve root causes and prevent future denials.

Financial Reporting & Analysis:

• Prepare and present regular revenue cycle performance reports to senior management, highlighting key performance indicators (KPIs) such as days in accounts receivable, denial rates, and collection efficiency.
• Analyze data to identify areas of improvement in the revenue cycle and implement strategies for increasing efficiency and collections.

Compliance & Audits:

• Ensure all revenue cycle processes adhere to regulatory guidelines, including HIPAA, Medicare, Medicaid, and commercial insurance policies.
• Stay current with changing healthcare regulations, payer policies, and industry best practices.
• Lead or coordinate internal and external audits of revenue cycle operations to ensure compliance and identify potential areas for improvement.

Staff Management & Development:

• Lead, train, and mentor RCM team members to promote professional development and high-performance standards.
• Set clear performance expectations, provide constructive feedback, and foster a collaborative work environment.
• Conduct regular performance evaluations and develop training programs to address skills gaps or process inefficiencies.

Collaboration:

• Collaborate with clinical, operational, and financial teams to ensure smooth workflows and effective communication regarding the revenue cycle.
• Work with payer representatives to resolve issues related to reimbursement rates, claim rejections, and disputes.
• Communicate effectively with patients regarding their bills, insurance claims, and any necessary follow-ups.

Process Improvement:

• Continuously evaluate and improve revenue cycle processes for greater efficiency, reduced errors, and faster payments.
• Implement best practices and industry-standard technology solutions to streamline the revenue cycle process.
• Recommend and assist in the adoption of new software or tools to enhance RCM performance and efficiency.

Requirements:

Education: Bachelor’s degree in healthcare administration, Business Administration, Finance, or a related field. Certification in Revenue Cycle Management (e.g., Certified Revenue Cycle Executive (CRCE) or Certified Professional Coder (CPC)) is preferred.

Experience: Minimum of 5 years of experience in healthcare revenue cycle management, with at least 2 years in a managerial role.

Skills:

• In-depth understanding of healthcare regulations, payer contracts, and compliance issues (HIPAA, Medicare, Medicaid).
• Strong analytical, problem-solving, and decision-making skills.
• Excellent communication and interpersonal skills, with the ability to lead teams and collaborate across departments.
• Strong attention to detail with the ability to work under pressure and meet deadlines.
• Strong knowledge of medical coding, billing procedures, payer guidelines, and insurance processes.
• Experience in using RCM software, practice management systems (e.g., Epic, Cerner, NextGen), and electronic health records (EHR) systems.
• Proven track record of improving accounts receivable turnover and reducing claim denials.

Expert Knowledge : In-depth understanding of healthcare regulations, payer contracts, and compliance issues (HIPAA, Medicare, Medicaid).

Analytical & Strategic Thinking : Strong analytical, problem-solving, and decision-making skills.

Communication & Collaboration : Excellent communication and interpersonal skills, with the ability to lead teams and collaborate across departments.

Detail-Oriented : Ability to set and maintain priorities in a fast-paced environment, with multiple demands and interruptions.

Resource Optimization : Develop strategies to align onshore and offshore teams effectively, optimize resource allocation, and identify cost-saving opportunities across both locations. 

Client Relationship Management : Exceptional customer service skills and ability to cultivate strong relationships with clients to ensure satisfaction and retention.

Customer service skills: Strong customer service skills to manage relationships with clients, including communicating with them to resolve service delivery issues and promote client satisfaction.

Collaborative Problem Solving : Ability to work and communicate effectively with a diverse group of people including other department managers, staff, physicians, patients, and the client.

Technical skills: Should be familiar with medical billing software and other related technologies, such as electronic health records and practice management systems. Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and financial management tools.

Adaptability and flexibility: Should be able to adapt to changes in regulations, technologies, and industry trends and adjust the revenue cycle management strategy accordingly.

Team Development : Skilled in recruiting, mentoring, and leading high-performing teams to achieve or surpass performance objectives.

Performance Management: Ability to monitor team performance and make adjustments as needed to improve team and individual performance.

Team Building: Ability to build and lead a high-performing team that is capable of meeting or exceeding performance goals.

Since 2002, organizations across the entire healthcare spectrum have leveraged our deep expertise and high-quality solutions to maximize revenue, reduce operating costs and navigate the changing healthcare landscape.Medusind’s unique combination of deep industry expertise, robust operational capability, and client-focused service significantly improves the efficiency and profitability of healthcare organizations. Client satisfaction is the primary focus of the Medusind leadership and staff.Our highly experienced personnel, cutting edge technology, and forward thinking approach allows us to deliver effective solutions while staying ahead of healthcare industry changes.

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