Manager, RCM

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RCM Manager

The Manager, RCM is responsible for overseeing all revenue activities and strategizing ways to increase company profitability among AdaptHealth regions. Leads a designated RCM domestic and offshore team to manage all patient and payors accounts receivable to maximize revenue collected. Works closely with mid to low level managers to ensure all unprocessed claims and denials are reviewed, worked, reprocessed, or credit adjusted off.

Job Duties:

• Oversees designated Revenue Cycle Management domestic and offshore staff to ensure all RCM functions are worked within the established timeframes.
• Overall responsible for day-to-day management and processes of RCM team regardless of if location.
• Works with Team Leads to create daily, weekly, monthly, and quarterly key performance Indicators for RCM offshore staff.
• Tracks, trends, and publishes ongoing metrics for RCM work completed.
• Keeps abreast of all reimbursement billing procedures of third party, private insurance, and government regulations to ensure compliance with current processes.
• Ensures valid insurance information provided to our patients is accurate and complete. Works with staff to resolve discrepancies and improve accuracy ongoing.
• Maintains a strong working knowledge of both upstream and downstream processes.
• Provides feedback and recommendations on improving systems and processes.
• Improves processes within department with emphasis on quality and efficiency, while identifying and removing bottlenecks.
• Anticipates and resolves problems demonstrating good judgment.
• Reports audit metrics for employees to monitor accuracy and productivity rates.
• Complies with federal, state, and local legal requirements by being aware of existing and new legislations.
• Trains and develops team members to ensure AdaptHealth policy and protocol is being followed.
• Takes escalated phone calls that cannot be effectively resolved by team members.
• Communicates with other departments including front end staff regarding billing issues and trends to work toward an account resolution and decreases insurance denial percentages within AdaptHealth.
• Handles all insurance payer disputes that are filtered into department.
• Identifies trends and root causes related to inaccurate insurance billing and reports to manager while resolving account errors.
• Conducts team meetings to educate on insurance guidelines, claim denials, and re-training efforts on accounts incorrectly worked.
• Investigates escalated insurance billing inquiries and inaccuracies and takes appropriate action to resolve the account.
• Provides quality payer feedback to other AdaptHealth leadership.
• Develops and maintains working knowledge of current HME products and services offered by the company.
• Works with leaders and contract price table management to assure that all accurate billing and payor information is added into the AdaptHealth system.
• Ensures that RCM staff completes all month end processes prior to month end close.
• Responsible for selection and hiring of qualified staff, ensuring an effective on-boarding, and providing comprehensive training and regular feedback.
• Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards.
• Establishes annual goals and objectives for the department based on the organization’s strategic goals.
• Responsible for achieving organizational performance and retention goals, including timely completion of performance evaluations.
• Other duties as assigned.

Minimum Job Qualifications:

• Associated degree from an accredited college is required, advanced degree preferred.
• Three (3) years’ work related in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry required.
• Two (2) HME claims experience is preferred.
• Exact job experience is considered any of the above tasks in a Medicare certified HME, IV or HH environment that routinely bills insurance.

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual’s race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.