Patient Service and Revenue Manager (2275)

Patient Service & Revenue Manager
Reports to Chief Executive Officer

Position Summary

The Patient Service & Revenue Manager is responsible for leading all front-end revenue cycle operations within the
orthopedic practice to ensure an exceptional patient experience while maximizing financial performance. This position
oversees patient access processes including registration insurance verification referrals authorizations point-of-service
collections patient estimates and front office workflows that directly impact clean claims and revenue capture.
The manager serves as the primary liaison between the practice and the Revenue Cycle Management (RCM) department
ensuring operational alignment resolving front-end billing issues and providing onsite support to patients and staff
regarding insurance and financial questions.

Essential Responsibilities
The essential duties of the position include the following. Other duties may be assigned.

Patient Access Operations
Oversee daily operations of front office check-in and check-out processes.
Ensure accurate patient registration and demographic information.
Monitor workflows to improve efficiency patient satisfaction and revenue integrity.
Ensure timely and accurate collection of required documentation.

Revenue Integrity
Ensure clean claim generation through accurate front-end processes.
Monitor registration accuracy insurance verification and documentation requirements.
Reduce claim denials related to registration eligibility authorizations and referrals.
Partner with RCM to identify trends and implement corrective action plans.

Insurance Verification Referrals & Authorizations
Oversee insurance eligibility verification processes.
Ensure appropriate referrals and prior authorizations are obtained before services.
Supervise staff responsible for prior authorizations.
Serve as the subject matter expert for payer requirements and insurance-related questions.

Patient Financial Services
Ensure accurate patient estimates are generated.
Oversee surgery estimates and collections.
Ensure appropriate time-of-service collections are obtained.
Assist patients with estimate questions and straightforward account balance inquiries.
Escalate complex billing concerns to Revenue Cycle when appropriate.

Training & Staff Development
Train and mentor front office staff and management regarding:
o Insurance coverage
o Referral requirements
o Prior authorizations
o Patient estimates
o Collection policies
o Financial counseling basics
o Registration accuracy
Develop standardized workflows and educational resources.
Monitor staff competency and provide ongoing coaching.

Revenue Cycle Collaboration
Serve as the operational liaison between clinic leadership and the Revenue Cycle department.
Participate in revenue cycle meetings and initiatives.
Communicate payer changes and workflow updates to clinic staff.
Assist with implementation of new revenue cycle processes.
Help resolve front-end billing issues before they become claim denials.

Patient Experience
Provide onsite assistance for patients with:
o Estimate questions
o Insurance coverage questions
o Time-of-service payment expectations
o Basic account balance inquiries
Promote a positive financial experience through clear communication and compassionate service.

Performance Monitoring
Monitor key performance indicators including:
o Clean claim rate
o Front-end denial trends
o Point-of-service collection rates
o Authorization completion
o Estimate accuracy
o Registration accuracy
o Patient satisfaction related to access and financial services

Develop action plans to improve operational performance.

Qualifications

Education
Bachelors degree in Healthcare Administration Business Administration or related field preferred.
Equivalent healthcare leadership experience may be considered.

Experience
Five or more years of experience in physician practice operations revenue cycle patient access or medical office
management.
Orthopedic practice experience preferred.
Supervisory or leadership experience preferred.

Knowledge
Strong understanding of:
Medical insurance plans
Commercial and government payers
Prior authorizations
Referrals
Medical terminology
Patient financial counseling
Revenue cycle operations
Medical billing fundamentals
Point-of-service collections
Clean claim principles
Practice management systems and electronic health records

Skills
Strong leadership and coaching abilities
Excellent customer service and communication skills
Ability to resolve patient concerns professionally
Strong analytical and problem-solving skills
Ability to collaborate across departments
Detail-oriented with excellent organizational skills
Ability to manage multiple priorities in a fast-paced clinical environment

Success Measures
Success in this position will be demonstrated by:
Improved clean claim rate
Reduced front-end claim denials
Increased point-of-service collections
Timely completion of authorizations and referrals
High patient satisfaction with financial communication
Well-trained knowledgeable front office staff and management
Strong collaboration between clinic operations and Revenue Cycle
Consistent compliance with payer requirements and organizational policies