RCM Referral & Eligibility Manager

Job Description

Oversee all eligibility verification and authorization procurement activities for all service lines. Responsible for the team’s production and the completion of designated KPIs. Manage the R/E process to ensure that the avoidable denial percentages are within acceptable ranges. Review and interpret monthly denial reports to identify areas of opportunity. Monitor staff for compliance of the organization’s confidentiality policy in accordance with the Health Insurance Portability and Accountability Act (HIPAA) regulations. Seek opportunities for automation and/or disruption in the traditional methods to reduce denials. Ensure staff production, quality and compliance is maintained to company standards by assigning tasks to staff and monitoring to ensure performance. Identify and resolve problems and inconsistencies. Identify opportunities to build process and communication workflows with practice staff and/or management. Assist Revenue Optimization Specialist (ROS) for R/E in staying current on all payer bulletins and communicate pertinent information to staff. Work with ROS to design, implement or evaluate staff training and performance measurement criteria. Recruit, interview and select new employees with assistance from human resources. Responsible for supervising assigned staff, including attendance, paid time off, payroll, training, corrective action and performance evaluations. Develop work schedules according to budgets and workloads. Complete all tasks assigned by the Director in a timely manner.

Qualifications

1. 5 years of experience in revenue cycle management firm or billing office or medical practice 2. Proven experience with management of staff 3. Practicing knowledge of the entire revenue cycle including, intake, charge entry, accounts receivable, cash application, customer service, and credentialing 4. Demonstrate knowledge of government and managed care program as well as industry terms 5. Ability to maintain HIPAA as well as other compliance requirements 6. Proven analytical skills