Professional Revenue Cycle Manager

SUMMARY:

Under the guidance of the PB Director of the Physician Revenue Cycle, the Professional Revenue Cycle Manager provides strategic support in the management of third-party payer relationships, ensuring timely and accurate claims submission and reimbursement across various insurance payers, including governmental or third-party agencies. This role actively plans, develops, organizes, and manages multiple areas of responsibility as assigned by senior leadership, guiding managers and/or supervisors in their performance to meet/exceed key performance indicators related to financial metrics, regulatory compliance requirements, and organizational strategic goals. Manage financial initiatives related to billing and collecting revenue for medical services. Ensures claims adhere to appropriate coding and billing requirements, detects erroneous claims, and resolves any disputes related to payment. This encompasses the secure transmission of electronic health records. Ensures PFS Managers, Supervisors and staff are following appropriate and consistent workflows.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect and Excellence, as these values guide our everyday actions with patients, customers and one another.
In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:

Instill Trust and Value Differences
Patient and Community Focus and Collaborate

In addition, our leaders will demonstrate an aptitude for:

Ensure Accountability and Build Effective Teams
Drive Vision and Purpose and Optimize Work Processes

By applying core and leadership competencies, leaders help Brown University Health achieve its strategic goals.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Actively manages, plans, develops, and organizes multiple areas of responsibility as assigned by Senior Leadership. Practice excellent time management to be available to attend meetings for Leadership of all responsibilities.
• Oversee the account receivables of all areas of professional net revenue operations. Strategically monitors, develops and implements ways to protect the financial stability of professional revenue. Supports, develops, and analyzes account receivable reports and provides findings to the Director of the Physician Revenue Cycle on a frequent basis.
• Oversees insurance payors to ensure timely, accurate claims submission and claims reimbursement. Reports, analyzes, and monitors accounts receivable for all payors, communicating findings to leadership with status updates or escalation as needed.
• Assess and understands business processes of the Revenue Cycle from registration to billing operations. Anticipates needs of the department and pursues solutions. Displays extensive historical and current knowledge of information system technologies and our internal systems to ensure optimum efficiency in department's operations.
• Responsible for managing or participating in meetings with payers (JOC - Joint Operating Council), practice leadership, OP Denial Team and other Revenue Cycle departments. Provides appropriate planning to address payer payment issues and creates new ways to mitigate risks.
• Is active in various meetings within PFS to ensure continued focus and improvements in our patient and insurance collection practices. Participate in Denial Management, Contract Management, Agency Tracking, external business partner meetings, and various other committees for PFS department.
• Guided by departmental action plans and strategic priorities, impacts own and other teams' ability to achieve service, quality, and timeliness of objectives
• Performs other duties as assigned.

EDUCATION:

Bachelors preferred but not required: in business, healthcare or health services administration, health information management, communications, finance, accounting, public administration, or management.

EXPERIENCE:

Requires practical experience in leading and managing the execution of processes, projects and tactics within a job family group and/or job family; possesses advanced experience and skills. Five to ten years' progressive management experience in Patient Financial Services related responsibilities.

SUPERVISORY RESPONSIBILITY:

Manages a team typically comprised of other Managers and/or Supervisors and Experienced Professionals; follows processes and operational policies in selecting techniques for obtai

Pay Range:

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

Work Type:

Work Shift:

Daily Hours:

Driving Required: