Customer Relationship Management CRM

Roles and responsibilities

Position Overview: We are seeking an experienced RCM (Revenue Cycle Management) Manager to oversee and optimize the revenue cycle operations within our hospital setting. The ideal candidate will have at least 5 years of experience in RCM, with a strong understanding of healthcare billing, coding, insurance verification, and compliance. You will lead a team to ensure timely and accurate claims submission, collections, and revenue maximization.

Key Responsibilities:

Manage end-to-end revenue cycle processes, including billing, coding, collections, and accounts receivable.
Collaborate with clinical and administrative teams to ensure proper documentation and coding accuracy.
Analyze revenue cycle performance metrics, identify inefficiencies, and implement improvements.
Ensure compliance with healthcare regulations, payer requirements, and internal policies.
Provide training and mentorship to the RCM team.
Managing the Revenue Cycle
Oversee the end-to-end revenue cycle process, from patient registration to final payment.
Ensure smooth operations across all stages of the cycle (pre-visit, visit, post-visit).
Collaborate with billing, coding, and insurance departments to ensure accuracy in billing processes.
Team Leadership
Lead and manage a team of revenue cycle specialists, billing and coding professionals, and other relevant staff.
Provide training, development, and performance evaluations for team members.
Motivate the team to meet departmental goals and improve key performance indicators (KPIs).
Compliance and Regulatory Management
Ensure adherence to federal, state, and payer-specific regulations, such as HIPAA, CMS guidelines, and coding standards.
Conduct audits to ensure compliance and identify areas for improvement.
Stay updated on industry changes, payer regulations, and coding updates.
Claims Management
Oversee the submission and management of claims to insurance companies.
Ensure accurate coding, billing, and timely submission of claims to avoid delays in reimbursement.
Resolve denials, rejections, and unpaid claims through follow-ups with insurers and payers.
Identify trends in claim denials and work to correct issues.

Desired candidate profile

Minimum 5 years of RCM experience in a hospital or healthcare environment.
Strong knowledge of healthcare billing, coding, and insurance claims processes.
Excellent leadership, communication, and problem-solving skills.
Familiarity with electronic health records (EHR) systems and revenue cycle software.
Revenue Optimization
Analyze financial data to identify areas of revenue leakage and inefficiency in the revenue cycle.
Develop and implement strategies to increase collections, reduce denials, and improve the overall revenue cycle process.
Work with departments to ensure accurate patient data and insurance information.
. Reporting and Analysis
Prepare and present regular reports on key performance indicators (KPIs), including days in accounts receivable, collection rates, denial rates, and revenue cycle performance.
Monitor trends and provide recommendations for improving the efficiency and effectiveness of the revenue cycle.
Analyze financial metrics to assess the health of the organization’s revenue stream.
Payer Relations
Develop and maintain relationships with payer representatives, working to resolve issues related to claims, payments, and contract disputes.
Negotiate payment rates and other contract terms with insurance providers.
Ensure that reimbursement rates are in line with expectations.
Process Improvement
Identify and implement process improvements that enhance the efficiency of the revenue cycle.
Streamline workflows to reduce errors, delays, and overhead costs.
Recommend technology or system upgrades to improve billing, coding, or claims management.
Customer Service and Patient Interaction
Ensure that patients receive clear and accurate billing information.
Resolve patient inquiries related to billing, insurance, and payment issues.
Work to maintain patient satisfaction while ensuring that payments are collected promptly.