TrueCare · 1 day ago
Manager ,Revenue Cycle (Back End)
San Marcos, CA
Full-time
Onsite
Mid Level
$91K/yr - $136K/yr
3+ years expTrueCare is a trusted healthcare provider serving San Diego and Riverside Counties, offering compassionate and comprehensive care to underserved communities. The Back-End Patient Financial Services (PFS) Manager is responsible for managing the billing staff's daily activities to ensure accurate billing and compliance with revenue goals.
Hospital & Health Care
Responsibilities
Manage the day-to-day operations of the PFS department by providing direction, scheduling assignments, coordinating workflow, and assigning priorities
Develop training and performance standards and measures consistent with industry healthcare standards and ensure achievement of goals
Provide oversight of the billing cycle to maximize revenue and manage accounts receivable balances
Establish, implement, and provide direct oversight of departmental productivity standards ensuring accurate and timely submission of all claims to maximize potential revenue
Develop and implement feedback mechanisms for resolution of most frequent/costly denials in a timely fashion to improve billing efficiencies and cash flow
Ensure timely billing and collection of all Program Income, including Federal and State agencies, insurance companies, patients, and other third-party payers
Implement and maintain systems to audit billing submissions, payment posting, collections, denials, and adjustments including write-offs to ensure accuracy of accounts receivable, timely claims adjudication, and revenue maximization
Operationalize coding changes, program updates, and regulatory changes organization-wide, including PFS, practice management (system and key players), and clinical operations
Assist, as needed, with billing/audit questions, ambulatory inquiries, education, database maintenance, statistical analysis, and processing of reviews of internal audits
Develop reports and analysis, as needed, to monitor revenue, quality, quantity, timely submissions, coding compliance, and general billing standards to meet Federal, State, health plan, and local requirements
Analyze trends of coding, charges, collections, adjustments, write offs, and accounts receivable balances and make appropriate changes to align staff and maximize revenue
In collaboration with the Revenue Cycle Director, ensure health plan information is up to date
In collaboration with Medical Staff Office, ensure timely insurance plan enrollment for providers
Manage daily, monthly, and annual close processes including the distribution of system generated financial reports
Assist in assuring that all billing department policies and procedures are accurately documented on PolicyTech by providing the Revenue Cycle Director with changes as they are identified
Ensure implementation of all billing and coding plans, programs, and projects among the team
Maintain a working knowledge of departmental coding operations and act as an in-house expert on issues pertaining to specialty coding and reimbursement
Assist in the annual independent audit as related to Program Income and Accounts Receivable matters. Provide responses to all internal and external audits as well as compliance audits and issues
Qualification
Required
Bachelor's degree from an accredited institution in business, healthcare administration, or a related field or an equivalent combination of education and professional experience in a related field
A minimum of two (2) years prior supervisory experience
A minimum of three (3) years of experience in healthcare operations, business, or administrative functions
Experience working in a community clinic or a Federally Qualified Health Center (FQHC)
Knowledge of HIPAA privacy and security regulations
Working knowledge of CPT, ICD9 and ICD10 codes, third party payor reimbursement including community clinic or FQHC expertise, billing and insurance regulations, medical terminology, insurance benefits, and appeal processes
Knowledge of third-party billing and state and federal collection regulations
Experience with an electronic health record system
Proficiency in Microsoft Office suite products, including Outlook, Word, Excel, and PowerPoint
Preferred
Management experience
Experience in an ambulatory setting, with medical billing and collections
A minimum of one professional coding or healthcare compliance certification (such as Certified Coding Specialist – Physician-based, Certified Professional Coder, Registered Health Information Administrator, or Registered Health Information Technician)
Two to three years of coding experience
Benefits
Competitive Compensation
Competitive Time Off
Low-cost health, dental, vision & life insurance
Tuition Reimbursement
Employee Assistance program
Company
TrueCare
For over 50 years, TrueCare has remained steadfast in its commitment to its patients, their families, and our communities.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Briana Cardoza
Chief Buisness Development Officer
Claire Wilson, SHRM-CP
Human Resources Business Partner
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