Revenue Cycle Lead

Statement of Purpose

The Lead serves as the primary point within the Revenue Cycle Management (RCM) team, providing advanced support in patient accounts, billing resolution, payer follow-up, denials management, and patient financial communication. This role supports leadership by providing front line patient account resolution, workflow guidance, day-to-day trend identification, identifies systematic and/or payer related issues, and cross-department collaboration. The RCM Lead provides day-to-day operational guidance, training support, facilitates implementation of leadership and organization directives, and escalates handling of identified issues to ensure accurate billing, timely collections, regulatory compliance, and an exceptional patient experience as it relates to RCM.

• Performs advanced action and team support for RCM team functions including but not limited to coding, billing, collections, denials, AR aging, payment plans/options, and insurance benefits.
• Resolve high-dollar aged patient accounts, including insurance, self-pay, and mixed-coverage.
• Perform preliminary claim analysis to identify root causes of denials, underpayments, payment delays and other aspects of claims’ processing impacting revenue.
• Ensure accuracy of team’s work including but not limited to posting of payments, adjustments, credits, and reconciliation in accordance with organizational policy.
• Serve as primary point for patients’ account resolution
• Perform and provide support to the team regarding denials prevention, appeal preparation, and payer follow-up.
• Support clean claim initiatives by validating documentation, coding alignment, and charge accuracy.
• Oversee processing and follow up of sliding fee discount program applications, recertification, and documentation and payment plans.
• Assist leadership with implementation of process improvement initiatives.
• Conduct workflow reviews, and quality assurance activities.
• Other duties as relevant.

• Minimum of 3 years of experience in Revenue Cycle.
• Demonstrated knowledge of medical billing, insurance verification, collections, denials, and AR workflows
• Experience working in FQHC, hospital, or large multi-specialty healthcare environment required.
• Revenue cycle certifications (CRCR, CHFP, CPC, or equivalent), preferred.

• Strong understanding of Medicare, Medicaid, Florida managed care, and commercial payer requirements and systems
• Strong analytical, problem-solving, and critical thinking skills
• Excellent written and verbal communication skills
• High attention to detail and organizational skills
• Knowledge of sliding fee discount programs and patient financial assistance policies, preferred
• Familiarity with payer contracts and reimbursement methodologies
• Ability to quickly learn and work in EMR system- eClinical
  
  Works.
• Exceptional skills with Microsoft Office Suite programs
  - Excel knowledge necessary;
  SharePoint a plus
• Demonstrated ability to resolve patient financial concerns with professionalism and accuracy.
• Must be able to thrive in a busy environment with changing priorities.

• Must possess and maintain valid Florida driver’s license and proof of insurance
• Must have reliable and accessible auto vehicle.
• Must pass necessary fingerprinting, Level II background checks and employment eligibility verification through the U. S. Department of Homeland Security’s E-Verify system, (Use the "Apply for this Job" box below)..