Revenue Cycle Manager - Ambulatory Care

Duties may include but are not limited to the following:

• Oversees denial prevention activities for ambulatory care including eligibility denials and billing holds;
• Supervises ambulatory cares billing team including performing evaluations and making recommendations for career development;
• Reviews aging report and KPIs with the billing staff routinely to ensure unbilled activity and aging goals are met while recommending improvements based on trends;
• Evaluates billing errors and provide updates and training recommendations to stakeholders;
• Regularly meets with Ambulatory Care COO and VCMS Revenue Cycle Director to provide updates and recommendations regarding departmental performance;
• Analyzes and maintains appropriate eligibility and billing procedures to ensure compliance with fiscal policies;
• Conducts meetings on a regular basis with the ambulatory care billing management and clinic staff to discuss any procedural changes as well as to keep team informed of changes to coding health plans/programs or other regulatory requirements;
• Conducts monthly meetings with ambulatory care billing team to discuss workflow goals and development opportunities while engaging the PFS Team to ensure topics align with reporting metrics;
• Prepares and evaluate revenue cycle reports (such as monthly reports ad hoc reports etc. in order to analyze the billing functions and accounts receivable and make recommendations to the CFO and leadership as needed;
• Maintains regular communication and coordination with central billing team;
• Attends conducts and/or facilitates interdepartmental meetings to optimize workflows for all revenue cycle related matters;
• Creates updates training and documentation related to billing. Coordinates training and support for staff members and keeps up to date with state programs specialty programs and thirdparty payers billing guidelines and updates;
• Identifies and monitors compliance of coding and billing of all interdepartmental functions services supplies medications and overall other revenue cyclerelated areas;
• Assists with monitoring and review of ambulatory care charge master to ensure it is updated with new and expired activity. Monitor charges and various reporting to ensure updates are appropriate and are made timely; and
• Performs other related duties as required.

These are entrance requirements to the exam process and assure neither continuance in the process nor placement on an eligible list.

Any combination of education and experience which has led to the acquisition of the required knowledge skills and abilities.

The required knowledge skills and abilities can typically be obtained by:

Staff/Services Manager II: Five 5 years of experience in financial operations related to billing and collecting revenue for medical or health services which includes 3 years of supervisory experience that includes writing performance evaluations.

Staff/Services Manager III: Seven 7 years of experience in financial operations related to billing and collecting revenue for medical or health services which includes 4 years of supervisory experience that includes writing performance evaluations.

NECESSARY SPECIAL REQUIREMENTS:

• Possession and maintenance of a California driver license throughout the course of employment
• Previous experience in hospital admitting outpatient primary care or specialty clinic setting
• Previous experience working with any of the following state programs and rules:
  • MediCal Programs including MediCal Managed Care
  • Commercial Insurance
  • Medicare

DESIRED:

• Bachelors degree in business administration health sciences or a related field.
• Possession of a coding certificate
• Knowledge of Federally Qualified Health Center (FQHC) system
• Experience using Electronic Health Records particularly Cerner and Epic

Considerable (Level II) to thorough (Level III) knowledge of:

• medical reimbursement programs and complexity of payment systems
• Current Procedural Terminology Codes (CPT) practice management systems and electronic health records systems preferably Cerner
• International Classification for Diseases (ICD)10 codes Health Care Procedure Coding System (HCPCS) codes for payment processing of Medicare and/or MediCal
• MediCal Provider Manual for Billing and Policy and Program and Eligibility
• outpatient primary care and specialty clinic operations
• Microsoft Excel functions
• Eligibility and prior authorization requirements/process for commercial and government payors

Working ability to:

• analyze administrative and fiscal problems
• prepare a variety of reports and recommendations
• speak effectively in public
• plan organize and supervise the work of others; and
• safely drive a vehicle

FINAL FILING DATE: This is a continuous recruitment and may close at any time; therefore apply as soon as possible if you are interested. Your application must be received by County of Ventura Human Resources in Ventura California no later than 5:00 p.m. on the closing date.

To apply online please refer to our web site at ventura/jobs. If you prefer to fill out a paper application form please callfor application materials and submit them to County of Ventura Human Resources 800 South Victoria Avenue L1970 Ventura CA 93009.