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Legacy Community Health Services

Job: Revenue Cycle Compliance Manager

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Jobing Description

Legacy - Caroline

Requisition Number:

Position Status:
Full Time - Regular

FLSA Status:

Responsible for the development, preparation and presentations of reports that analyze the revenue cycle operations.  Under the direction and supervision of the V.P of Clinical Business Service, you will receive oversight and guidance to the follow-up, collections, cash posting, billing support and extended business office (EBO) units utilizing Legacy processes with a high level of knowledge, skills, abilities, and experience. This position is self-directed & requires a person that has experience supervising employees in the day-to-day tasks and responsibilities of the assigned groups within an environment that is dynamic and fast-paced. This position provides training to staff and seeks to streamline processes. Encourages communication in the workflow for continuous improvement. Sets clear production expectation and quality standards.

Essential Functions

Essential functions are those tasks, duties, and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable.

Prepare and submit reports to senior management
Responsible to assist in the development, implementation, and monitoring of productivity to ensure standards are met.
Required to support and work with management in the development of policies
Strong understanding of Extended Business Office processes and ability to become proficient in multiple disparate systems for billing, medical records, and document storage.
Good working knowledge of HCPCS, CPT, and ICD10 codes
Must understand HIPAA compliance, FDCPA laws, state/federal guidelines for billing/collections as they relate to healthcare providers
Assesses accuracy of demographic and policy information within patient accounts. Photocopies patients' identification and/or insurance cards as appropriate.
Reviews patient insurance policy information and works with providers to obtain authorization and referrals, as necessary.  Updates this information within medical software program.
Assists in reconciling deposit and patient collections.
Participates in the Performance Improvement Program.
Identifies trends, and carrier issues relating to billing and reimbursements.  Reports findings to Supervisor.
Works independently.
Analyzing and interpreting that claims are accurately sent to insurance companies.
Answers/responds to correspondence related to patient accounts. Is available to answer billing and charge related inquires by patients, staff, managed care organizations, etc.
Researches, records findings, and communicates effectively with Manager to achieve optimum performance.
Pursues and participates in education to remain current with changes in the Healthcare industry.
Maintains patient confidence and protects medical office operations by keeping patient information confidential.
Performs follow up with insurance companies on unpaid insurance accounts identified through aging reports
Contributes to team effort by accomplishing related results as needed.
Communicates with Leads to identify and resolve all audit review issues. 
Other duties as assigned

Education & Training Requirements

Bachelor’s Degree or at least two years of relative experience.

Work Experience Requirements

Minimum of 4-6 years of related experience in a business, medical or technical environment

Previous experience in a medical office setting and/or experience with an Electronic Medical Record a plus.
Background in ICD-A / CPT codes preferred.
Knowledge of medical terminology and billing practices preferred.
Customer service driven.
Understanding of medical terminology and insurance laws/guidelines. 
Excellent organization and time management skills along with excellent oral and written communication skills.
Strong team player.
Ability to learn quickly, build and maintain long term relationships and work with minimal supervision

Skills / Requirements

Important Notes

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