Sr. Manager, Revenue Cycle (OH & CT)

Under the direction of the Sr. Director, of Revenue Cycle Management, the Senior Manager, Revenue Cycle Management, is responsible for oversight and training of staff, management of functions and processes and accountable for the team hitting performance, quality and production metrics. In addition, the Sr. Manager will support RCM Associate Directors with escalations and larger strategic projects as needed.

The Sr. Manager is responsible for ensuring that the Accounts Receivables are worked in accordance with best practices and that all Manager Holds, Zero Pay, Unapplied, Unpostables and other Aged Accounts Receivable are reviewed, reconciled and resolved in a timely and compliant manner.

Additionally, the Sr. Manager will take steps necessary to resolve all claim issues or questions that escalate to the RCM team. Resolution of SalesForce cases and management of issues as well as management of the team resolving the cases is a key element in this role. We look for strong training and claims management skills along with a strict attention to detail, a solutions focused mindset, and a driving work ethic.

Primary Job Duties:

• Oversee the entire claims submission and follow-up process, ensuring claims are submitted accurately and on time
• Lead and manage large payer projects and care center support projects, updating leadership and affected stakeholders as needed
• Keep ADs abreast of opportunities for improvement in daily operations along with recommendations on process improvements
• Management of the teams accountable for the accounts receivable (AR) including analysis and resolution of the aged AR, looking for root cause issues
• Utilize data to identify patterns in claim denials or delays and develop actionable solutions to address them
• Independent decision making -regarding claim adjustments, resubmission, appeals, and other claim resolution techniques
• Makes policy updates as needed, to all RCM policies.
• Meets with the Performance Operations, Implementation, Sales and other Privia teams, review escalated issues and discuss payer or claim concerns.
• Meets with Care Center leadership including the lead physician partners, office managers and other staff to discuss complex claim or other revenue cycle matters
• Responsible for training internal teams (Operations, Sales) as well as care center staff when appropriate
• Support care center go lives as needed, which may include overnight travel
• Laser focused drive toward achievement of department’s daily and monthly KPIs, requiring a team focused approach to attainment of these goals
• Responsible for performing or assisting with duties related to staffing to include hiring, termination, coaching and training
• Provides ongoing feedback to subordinate staff regarding of performance throughout the year to subordinate staff
• Counsels employees in disciplinary matters and obtains assistance from human resources appropriately for disciplinary actions and/or employee termination process
• Other duties as assigned