Long Tail Health Solutions · 1 day ago
Manager, Revenue Cycle
United States
Contract
Remote
Mid, Senior Level
5+ years expLong Tail Health Solutions is a provider advocate focused on optimizing the financial performance of healthcare providers through technology-enabled services. The Revenue Cycle Manager oversees all aspects of the revenue cycle, ensuring financial performance through optimized workflows and compliance with regulations while collaborating with various teams to enhance operational efficiency.
Computer Software
Responsibilities
Interviews, hires, orients, trains, develops and evaluates the performance of and, when necessary, disciplines and/or discharges department personnel. Provides direction, as necessary, to staff regarding sensitive and/or complex work, related problems, resolves complaints and response to inquiries regarding department operations
Provides ongoing education and coaching of department staff
Maintains a working knowledge of all current best practices for commercial and governmental payer denials management
Stay up to date with and disseminate current regulatory and payer trending information as formal education to appropriate staff
Evaluates team member comprehension and understanding of education
Oversee and manage phases of the revenue cycle, including patient access, utilization review, charge capture, coding, claims submission, payment posting, denial management, and collections
Develop and implement policies and procedures to enhance revenue cycle efficiency and reduce revenue leakage
Monitor key performance indicators (KPIs) such as clean claim rates, denial rates, days in accounts receivable (A/R), and reimbursement trends to ensure optimal financial performance
Analyze revenue cycle processes to identify opportunities for automation, process improvement, and cost reduction
Ensure accurate and compliant coding and documentation practices to maximize reimbursements and minimize denials
Collaborate with coding and clinical documentation improvement (CDI) teams to ensure proper charge capture and coding accuracy
Develop strategies to reduce denials and improve denial recovery efforts through root cause analysis and proactive process changes
Work with payers and internal teams to resolve claims issues, appeal denied claims and negotiate reimbursement rates when necessary
Work closely with finance, HIM (Health Information Management), patient access, and clinical teams to align revenue cycle processes with hospital operations
Serve as a liaison between the hospital and third-party payers to resolve payment disputes and maintain strong payer relationships
Optimize the use of hospital revenue cycle systems, including EHR, billing software, and financial reporting tools
Partner with IT to implement system upgrades, automation tools, and workflow enhancements
Ensure data integrity and accuracy in all revenue cycle-related reporting and documentation
Qualification
Required
Bachelor's degree in Healthcare Administration, Business, Finance, or a related field
5+ years of revenue cycle experience in an acute care hospital setting, with at least 2 years in a leadership role
Strong knowledge of hospital billing, coding (ICD-10, CPT, HCPCS), reimbursement methodologies (DRG, APC, Medicare/Medicaid, commercial payers), and revenue cycle compliance
Experience with EHR and revenue cycle management software (e.g., Epic, Cerner, Meditech)
Strong analytical, problem-solving, and decision-making skills
Excellent communication and leadership abilities with experience managing teams
Experience leading revenue cycle optimization projects and implementing process improvements
Familiarity with value-based care reimbursement models and contract negotiations
Knowledge of regulatory requirements including HIPAA, CMS guidelines, and payer policies
Proficient with principles of all payer types including managed care, Medicare/Medicaid, and private insurer reimbursement rules
Knowledge of medical necessity criteria, payer reimbursement arrangements, and denials management
Project management to ensure budgetary constraints and plan deadlines are met timely
Advanced problem solving to address complex cases, reimbursement trends and quality assurance
Customer service for providing solutions to payers, patients, clients and team members
Organizational skills to manage multiple tasks balancing team's strength to match department's workload
Interpersonal skills to help interact and work with team and clients effectively
Critical thinking to optimize day to day assignments, make necessary decisions on high risk/high dollar cases and respond appropriately to demanding client and payer needs
Strong communication and remote relationship building skills
Preferred
Master's degree in Healthcare Administration, Business, Finance, or a related field
Preferred certification in Revenue Cycle (CRCR, CHAM, or CPC) or related credential
Company
Long Tail Health Solutions
Long Tail Health’s technology-enabled services improve operational efficiency of healthcare operations.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Stephen Scott
Co-Founder, Chief Customer Officer
Company data provided by crunchbase