Revenue Cycle Manager
Framingham, MA Finance/Accounting
Description

Full time- Exempt/Salary

  • $1,500 Sign-on Bonus
  • Housing Resources Available
  • Tuition Reimbursement
  • Benefits include: Health; Dental; Vision; Life and Disability Insurance; Employer-Matching 403B; Sick/Personal/Vacation Time; Flexible Spending and Dependent Care



TLC Diversity Statement:
The Learning Center for the Deaf is on a journey to create an inclusive and welcoming space for people of all backgrounds. Together, we continue to build an inclusive culture that encourages, supports, and celebrates our TLC community members' diverse narratives. We embrace and value multiple approaches, experiences, and perspectives. TLC believes that diversity fosters innovation. We are committed to cultivating a place where everyone can feel they belong.


About TLC:
The Learning Center for the Deaf is a nationally-recognized leader of services for deaf and hard of hearing children, adults and families. To learn more, click here.

For our Mission, click here.


POSITION SUMMARY:

The revenue cycle manager is primarily responsible for ensuring accurate medical & behavioral health insurance claim submissions that enable our providers to receive maximum compensation for clinical services provided. Responsibilities include identifying patient reimbursement issues, ensuring that claims, denials, and appeals are efficiently processed, and resolving billing-related issues. This person will oversee 

patient billing, communications with health insurance, collections, cash posting, account management, credentialing and contract analysis. They will provide insurance billing and coding support as well as revenue cycle administration to Walden Community Services and the Outpatient Audiology clinic.


FUNCTIONS AND RESPONSIBILITIES:

  • Implement and maintain systems to ensure that accurate billing information is entered into the billing system including correctly coding diagnoses and procedures. 
  • Communicate with insurance providers, collections, cash posting, contract analysis, and billing and oversee daily insurance clearinghouse submissions from both community programs, reducing rejection rates and ensuring accurate first-time submissions
  • Manage claim reviews and first/second level appeals with both commercial and public insurance plans, if claims are paid incorrectly
  • Assist with obtaining and monitoring prior authorization for outpatient and durable medical equipment (DME) services, including intensive care coordination (ICC) for behavioral/mental health service visits among other mental health services 
  • Manage monthly and yearly revenue cycles; monitor reconciliation of payment rendered and claims submitted (general ledger revenue and accounts receivable) with reports generated from EHR(s) of both programs while working closely with directors of community programs to ensure the efficiency of systemic billing processes
  • Reconcile payments against billed amounts to ensure claims are processed properly, as well as collect private payments from accounts with outstanding balances

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Requirements
  • Certification in Professional Billing and Coding (CPC, CPB, or COC), or equivalent experience.
  • Bachelor’s degree in finance, business administration, healthcare administration, or related field and proficient in all Microsoft Office applications and medical office software.
  • Sound knowledge of health insurance providers and strict adherence to HIPAA and a minimum of 3 years of experience managing the billing process and revenue cycle for $1M+
  • Understanding of the insurance credentialing process for both provider and entity required, experience credentialing preferred
  • Strong interpersonal skills and excellent customer service skills. 
  • A minimum of conversational fluency in American Sign Language is preferred, a willingness to learn is required