Revenue Cycle Lead

Position Overview:

The Revenue Cycle Lead (RCL) is responsible for managing the revenue cycle, which is the process of generating, acquiring, and delivering revenue. Key responsibilities include processing and submitting claims to insurance companies and patients, following up on unpaid claims, resolving discrepancies with payers, ensuring timely collection of payments from insurance companies and patients. The Revenue Cycle Lead is also responsible for submitting and obtaining all necessary documentation to create revenue for insurance companies. RCL is required to understand and interpret payer contracts and work on and address any complex and intricate revenue-related issues. In addition, RCL will analyze accounts receivable reports, identify repetitive denials, systematic issues, and schedule meetings with payers. RCL needs to identify internal organizational errors arising from other departments and/or system configuration and take appropriate action to resolve them. RCL needs to provide solutions and assist in answering questions from Revenue Cycle Specialists, Revenue Cycle Specialists Senior, and Revenue Cycle Auditors. 

Essential Job Functions: Overall

• Meet with Revenue Cycle Supervisor and Manager to discuss areas of concern.
• Answers questions and provide solutions to Revenue Cycle Management team.
• Creates and updates Standard Operating Procedures (SOPs) and Work Aids for both domestic and global revenue cycle teams 
• Supports Daily and Weekly Communication of Payer, Product and Process Updates to both domestic and global teams
• Reviews request from team members for updates to payer / system configuration and submits to the appropriate team for system update 
• Monitor and report on key performance indicators related to revenue cycle activities, such as claim denial rates, time to payment, and outstanding accounts receivable, to identify areas for improvement.
• Work on complex and intricate revenue-related matters.
• Supports global team and provides feedback though QA, reviews and huddles.
• Monitors work completed by global partners and resolves tasks the global team cannot resolve.
• Trains and provides support to domestic and global team members
• Submits price table, payer rule, and system configuration updates to designated team.
• Implement and adhere to compliance standards and regulations related to medical billing and coding, maintaining confidentiality of patient information in accordance with HIPAA guidelines.
• Participate in the development and testing of new billing software and systems to improve revenue cycle efficiency, including providing feedback on software performance and suggesting enhancements.

Essential Job Functions: Insurance and Patient AR / Denials

• Process and submit insurance claims to various payers, ensuring accuracy in coding and billing information to minimize denials and delays.
• Review patient accounts to verify correct insurance billing information, update records as necessary, and resolve any discrepancies in patient account balances.
• Analyze denied claims to identify denial reasons and perform the necessary follow-up actions including appealing denied claims with appropriate documentation and justification.
• Analyze accounts receivable reports and take appropriate action to resolve repetitive denials.
• Coordinate with healthcare providers to obtain necessary medical documentation, referrals, or authorizations required for claim processing and reimbursement.
• Discusses areas needing improvement with the authorization and CMN departments as needed and offers solutions.
• Engage directly with patients to explain their bills, resolve billing inquiries, and set up payment plans for outstanding balances, ensuring a positive customer service experience.
• Engage in written communication and schedule meeting with payers to address aging balances.
• Compiles and submits projects to insurance companies.
• Meet with Revenue Cycle Supervisor and Manager to discuss areas of concern.
• Answers questions and provides solutions to RCM team.
• Supports auditors responsible for the production/quality of global team members.

Essential Job Functions: Unbilled Revenue

• Process and submit authorization and CMN requests to medical groups, plans, and physicians’ offices. Follow-up in a timely manner.
• Process eligibility verification and determine payer, benefits, and coverage criteria.
• Escalate any unbilled payer requirements for correction in the system
• Provide feedback to Intake team members on processing errors that have taken place.    

Essential Job Functions: Insurance Changes

• Process and submit insurance changes in a timely manner
• Submit updates to insurance selection tools if the insurance change is the result of a risk update that has taken place with the payer 
• Communicate with patients via appropriate mechanism (text, phone, e-mail, etc) to obtain insurance information or required information to qualify the patient 

Essential Job Functions: Cash Application and Refunds

• Process and apply insurance and patient cash in a timely manner 
• Monitor cash that is being received mail from payers.
• Determine alternate methods to receive payments from insurance. Submit requests to payers for ERA (Electronic Remittance Advise) and EFT (Electronic Fund Transfer)