Revenue Cycle Supervisor

Job Description

Job DescriptionSalary: $76,000-$96,000 per year

POSITION SUMMARY

Under the general supervision of the Director of Healthcare Operations, the Revenue Cycle Supervisor directs and coordinates the overall functions of billing, coding, and provider credentialing activities for the Health & Wellness Center. This position oversees internal business office staff and an external billing/coding vendor. In addition to driving optimal revenue cycle performance, the Revenue Cycle Supervisor directly supervises the Business Office Coordinatorsapproving timecards, providing coaching and counseling, and conducting performance evaluationsto ensure efficient and compliant operations.

ESSENTIAL FUNCTIONS

Supervision & Leadership

1. Directly supervise Business Office Coordinators, including approving timecards, providing coaching and counseling, and conducting performance evaluations.
2. Establish clear performance goals, mentor staff, and implement corrective action or performance improvement plans as necessary to maintain high-quality results.

Billing & Coding Management

1. Oversee all billing office functions, including billing, coding, charge entry, claim submissions, payment posting, and accounts receivable follow-up.
2. Ensure timely and accurate billing by collaborating with business office staff and clinical front office teams.

Policy Development & Compliance

1. Develop and maintain billing office policies and procedures related to coding, patient billing, and collections in compliance with all relevant laws and regulations.
2. Stay current with changes in coding, billing regulations, and compliance requirements; provide necessary updates and training to staff.

Vendor & External Relations

1. Manage the Health & Wellness Centers outside billing and coding vendor, monitoring performance and ensuring effective service delivery.
2. Collaborate with third-party credentialing vendors to ensure providers are credentialed accurately and in a timely manner.

Claims & Denials Management

1. Analyze billing and claims for accuracy, completeness, and prompt submission to governmental and commercial insurance entities.
2. Develop and maintain systems for adjustment analysis, including monitoring denials, tracking follow-up claim activity, and resolving payment discrepancies.

Operational Efficiency & Auditing

1. Audit billing processes regularly to identify inefficiencies, recommend improvements, and implement corrective measures to optimize the revenue cycle.
2. Maintain the fee schedule within the electronic health record (EHR).

Reporting & Analysis

1. Prepare and analyze accounts receivable reports, financial statements, and Key Performance Indicators (KPIs) related to the revenue cycle.
2. Identify trends impacting charges, coding, collections, or accounts receivable and recommend realignment of staff or revision of policies/procedures as necessary.
3. Collaborates with the Tribal Fiscal Department (CFO and/or Fiscal Department staff designated by the CFO) to assist with Tribal Fiscal Department responsibilities including audits and general ledger/RPMS A/R reconciliation.

Provider Credentialing & Enrollment

1. Complete applications for payer enrollment and re-validation as required.
2. Coordinate with credentialing entities and vendors to ensure provider credentials remain current and in good standing.

Regulatory & Annual Reporting

1. Coordinate the completion of Medi-Cal clinic reconciliations, ensuring timeliness and accuracy.
2. Maintain awareness of state and federal regulations and guidelines.

Training & Staff Development

1. Develop and deliver in-house training for front office staff, medical records staff, and providers on administrative processes and procedures related to billing and coding.
2. Foster a culture of professional growth, continuous learning, and teamwork.

Other Duties as assigned

1. Perform other job-related tasks as assigned by the Assistant Finance Director to support the Health & Wellness Centers mission and goals.

MINIMUM QUALIFICATIONS

1. Bachelors Degree in business administration, healthcare administration or related field, with a minimum of five (5) years of medical insurance/healthcare revenue cycle experience in a healthcare organization; preferably a Tribal Health Program, Federally Qualified Health Clinic, or similar outpatient clinical organization OR
2. Associates Degree in a related field, with a minimum of seven (7) years of medical insurance/healthcare revenue cycle experience in a healthcare organization; preferably a Tribal Health Program, Federally Qualified Health Clinic, or similar outpatient clinical organization.
3. Minimum of three (3) years of supervisory experience with demonstrated leadership skills in supervising, coaching, counseling and managing performance of support staff.
4. Demonstrated experience in account reconciliation within a finance department or similar environment, with the ability to identify and resolve discrepancies while ensuring compliance with established financial policies and procedures.
5. Working knowledge of front office and medical records processes in an outpatient clinical setting.
6. Working knowledge and experience operating in Electronic Health Record.
   1. Experience working in RPMS EHR is preferred, but not required.
7. Exceptional verbal and written communication skills.
8. Working knowledge of Microsoft Office products such as Word, Excel and Power Point.
9. Ability to operate general office equipment such as copiers and faxes in a clinical setting.
10. Post job offer: CPR/BLS certification, TB test, and annual flu shot (during flu season) are required as a condition of employment, unless a medical/religious accommodation request is provided. Hepatitis B Vaccine will be offered at no cost to employees, but it is not required.

NATIVE PREFERENCE

Preference in hiring is given to either the most qualified applicant or a Native American candidate who meets the minimum qualifications. When two (2) or more Native American candidates have comparable qualifications, the following order of preference shall apply: (1) Members of Shingle Springs Band of Miwok Indians; (2) Spouses or domestic partners (certified through Tribal Court) of members of Shingle Springs Band of Miwok Indians; (3) Parents of children of the Shingle Springs Band of Miwok Indians; (4) All other documented Native Americans; (5) All other applicants in accordance with Title 25, U.S. Code, Section 472 and 473. Applicants claiming Native preference must submit verification of Indian eligibility.