Mgr. RCM - Healthcare Revenue Cycle Management

The Manager of Revenue Cycle Management will play a pivotal role in ensuring the financial health of our organization by overseeing one of the four primary functional areas within the Revenue Cycle Management department. This role requires a highly analytical and strategic thinker who can lead the development and execution of revenue cycle strategies for their designated functional area, which consists of at least two RCM service lines.

The Manager will manage a team of in-house ATI employees and oversee the performance of a large offshore vendor team, comprising over 100 team members.

• Develop and execute the strategic direction for the designated functional area, aligning it with the overall goals of the organization and the Revenue Cycle Management department.
• Lead, mentor, and motivate a team of ATI employees to ensure optimal performance, productivity, and professional growth.
• Establish, monitor, and act on operational KPIs to enhance the efficiency and effectiveness of revenue cycle operations utilizing data-driven insights, with a deep understanding of their direct impact on ATI's Revenue Recognition model.
• Own the vendor relationship for their functional area, ensuring that they meet SLA performance metrics, adhere to policies/procedures, productivity & quality of day-to-day operations.
• Ensure all revenue cycle activities adhere to legal and regulatory compliance requirements (e.g., SOX compliance, Government & Commercial Payor guidelines, and internal ATI policies).
• Collaborate with other departments, such as Clinical Operations, IT, HR, and Finance, to streamline processes and improve revenue cycle outcomes.
• Generate regular reports for senior leadership, highlighting the performance and progress of the designated functional area.
• Coordinates with the Rev Cycle Optimization team on technology or process optimization projects.

Depending on the Functional area the following applies:

• Financial Clearance: If leading the Financial Clearance functional area, ensure timely verification of patient insurance coverage, eligibility, and authorizations. This functional area is also responsible for the Queue Management Team which maintains claim based work queues and processes all the faxes sent to clinics.
• Central Business Office: If overseeing the Central Business Office, oversee billing & rejection wqs, Documentation team, and Payment Posting including credit processing.
• Gov’t/Comm/SP AR Follow Up: Manage the resolution of government, commercial, and self pay accounts receivable issues, including denial appeals, unworked claims, and adjustment process. Responsible for the billing customer service team and resolving disputes timely, with an emphasis on patient satisfaction.
• WC/API AR Follow Up: If managing the WC/API AR Follow Up area, ensure efficient management of workers' compensation, personal injury, and auto accident-related accounts receivable. This includes both litigated and non-litigated AR.

Education Required:

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field or equivalent.

Experience Required:

• Minimum of 5 years of experience in revenue cycle management, with at least 2 years in a managerial or leadership role.
• In-depth knowledge of healthcare revenue cycle processes, including financial clearance, billing, collections, and accounts receivable.
• Proven experience managing both in-house and offshore team members.

Preferred:

• Physical Therapy or other professional billing experience.
• RCM Technology vendor experience.

Knowledge, Skills, and Abilities:

• Strong analytical and problem-solving skills, with the ability to use data to drive decision-making.
• Excellent communication and interpersonal skills.
• Understanding of healthcare compliance regulations, including HIPAA.
• Proficiency with revenue cycle management software.
• Excellent in Microsoft Office applications, capable of creating detailed analyses using pivot tables and other formulas/features within Excel.

Licenses and Certifications:

• Relevant industry certifications (e.g., HFMA, AAPC) preferred.