POSITION SUMMARY

Supports the VP of Revenue Cycle Operations and Optimization in managing aspects of revenue cycle optimization, including maintaining relationship and monitoring of third-party billing organization and EPIC hosting organization, identifying and implementing revenue optimization strategies, regulatory compliance with third-party insurers (Medicaid, Blue Cross/Blue Shield, etc.), and maintenance of billing and reporting systems. Collaborates with the VP of Revenue Cycle and Optimization in preparing, reporting on and ensuring compliance of fee schedules, contracts and credentialing activities for managed care contracts. Supports the VP of Revenue Cycle Operations and Optimization in leading strategic revenue cycle optimization initiatives that improve financial performance, operational efficiency, and regulatory compliance. Supports VP of Revenue Cycle Operations and Optimization with third-party Revenue Cycle Management (RCM) vendors and Epic managed services partners, identifies opportunities to optimize revenue, improve reimbursement, reduce denials, and enhance billing operations. Collaborates with clinical, operational, finance, information technology, and payer stakeholders to strengthen revenue integrity, reporting, reimbursement accuracy, and overall revenue cycle performance.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES

Management (10%)

Recruits, retains and develops a diverse and highly qualified staff; provides ongoing performance feedback and maintains a safe and professional work environment
Evaluates staff in a timely manner in accordance with PPGNY’s policies. Completes performance evaluations, goal setting, and corrective action processes in accordance with PPGNY policies. Partners with Human Resources and Revenue Cycle leadership on recruitment, onboarding, succession planning, employee engagement, and staff retention initiatives.
Performs other leadership, training, mentoring, and operational support responsibilities as assigned.
Promotes accountability, continuous improvement, operational excellence, and a culture of collaboration through effective leadership and mentoring.

Revenue Cycle Optimization and Revenue Cycle Liaison (55%)

Performs analysis of revenue cycle trends to identify opportunities to prevent denials, optimize reimbursement, improve first-pass claim acceptance, and maximize cash collections.
Performs root cause analysis of revenue cycle issues, develops corrective action plans, and implements process improvements to enhance revenue performance and operational efficiency.
Develops, executes, and manages work plans through completion, including billing corrections, reimbursement optimization, appeals, and workflow improvements. Partners with the Epic managed services organization and Information Technology to implement automation and system enhancements whenever possible.
Collaborates with third party RCM vendor to implement process changes
Collaborates with cross-functional teams to ensure alignment between clinical operations, revenue cycle workflows, payer requirements, and PPGNY billing practices.
Tracks adherence to implemented process changes, measures key performance indicators, and quantifies financial outcomes to ensure sustained operational improvements.
Monitors and reports key revenue cycle performance indicators including cash collections, days in accounts receivable, denial rates, clean claim rates, charge lag, timely filing, and underpayment recovery.
Monitors Health Centers’ adherence to charge reconciliation processes and key performance indicators, partnering with Health Center leadership to address trends, improve compliance, and optimize revenue performance.
Ensure changes within the charge description master (CDM) coincide and are implemented within clinical systems
Review changes in CPT®, HCPCS, and revenue codes for accuracy, compliance with applicable billing guidelines, and optimization of reimbursement
Identifies opportunities to automate manual revenue cycle processes through Epic optimization, workflow redesign, reporting enhancements, and collaboration with Information Technology and vendor partners.

Monitoring Tools (25%)

Provides guidance to the Senior Data Analyst in the development and implementation of reporting tools to identify revenue cycle trends, including root cause of denials.
Supervises the building of reporting tools (and periodically builds the reports directly) to monitor productivity and quality of work performed by staff that impacts RCM results, including front desk, financial counselors, and third party RCM vendor.
Works closely with Data Analytics team to develop dashboards, scorecards and other tools to monitor performance.

Education and Training (10%)

Develops and delivers training, or partners with appropriate departments to provide education, on revenue cycle processes, system enhancements, regulatory requirements, and operational best practices for Revenue Cycle and operational staff.
Maintain up to date knowledge of CMS billing rules and payer requirements to proactively identify policy changes
Remain current on Epic reporting tools

CORE COMPETENCIES

A demonstrated commitment to PPGNY’s mission related to bodily autonomy, health equity, gender and racial justice
A demonstrated commitment to learning about and enhancing practices related to racial equity and its impact on healthcare systems.
Strong relationship building and communication skills, including an ability to work and build trust across cultural differences related to related to race, class, age, gender, gender identity and expression, sexual orientation, religion, ethnicity, national origin or ability; and to reflect on one’s personal identity with humility.
Ability to mentor a culturally diverse team, including creating and sustaining an organizational culture that fosters inclusiveness and equity, and providing positive and developmental feedback and accountability related to practices including but not limited to equity
Strong knowledge of data and analytics to ensure good decision making, performance measurement and financial analysis.
Ability to work collaboratively in cross-organization workgroups.
Customer service and interpersonal skills and the ability to coordinate work with others, both internally and externally, to accomplish tasks.
Engages in mutual problem solving
Facilitates continuous process improvements
Strong time management skills, including ability to work in a high distraction environment and to juggle multiple deliverables at one time
Strong project management skills, identifying all steps required to meet deliverables, working with key stakeholders, in order to achieve goals, and barriers to success.

REQUIRED SKILLS/ABILITIES:

Interpersonal

Ability to remain focused and calm in stressful situations
Excellent interpersonal, written and verbal skills
Ability to develop and maintain effective, professional relationships with internal and external stakeholders

Technical

Proficient with Microsoft Office Suite; Advanced Excel skills including Pivot Tables and V Look Ups
Deep understanding of EMR systems; Experience in an EPIC environment
Strong data management and data analysis skills; research oriented with the ability to critically analyze large data sets

Subject Matter Knowledge

In-depth knowledge of Medicare/Medicaid regulations, including billing, coding, and documentation requirements.
Strong experience in revenue cycle management and optimization
Experience with principles of process improvement

Work Habits/Attributes

Excellent organizational skills
The ability to produce high-quality work in a fast-paced environment with changing and/or competing priorities
Ability to exercise sound judgment and independent decision-making skills
Ability to produce reliable, high-quality work with minimal direct supervision
Ability to exercise discretion in the handling of confidential information
Possess strong work ethic

REQUIRED QUALIFICATIONS

Minimum of an associate degree in business administration, accounting, healthcare administration, or other related degree.
Minimum 5 years of experience related to billing, coding, denial management and underpayment analysis
Demonstrated leadership skills
Two years’ experience with EPIC Reporting; (slicer/dicer or clarity)?

Preferred Qualifications:

Bachelor Degree
EPIC related certifications and reporting experience
Coding certification (e.g. CCS, RHIA, RHIT) or applicable experience

TYPICAL PHYSICAL DEMANDS

Requires prolonged sitting and repetitive tasks including use of a computer. Periodic standing, walking, bending. Requires lifting or moving of up to 15 pounds. Visual acuity is sufficient to perform frequent work on a computer screen and review printed reports and other materials. Requires the ability to hear and to communicate orally with others. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets, and will require reaching, grasping, pushing and pulling.

TYPICAL WORKING CONDITIONS

This job operates in a professional office environment. Potential exposure to communicable diseases and other conditions in a health center environment. Requires flexible schedule and during peak activity periods work in excess of 7.5 hours per day and/or 37.5 hours per week.

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