Revenue Cycle Manager (HYBRID)

Reporting to the Care Compass Finance Director and in support of the Southern Tier Region Social Care Network lead entity, the Revenue Cycle Manager will manage enhanced service claims and payment processes with a network of community organizations. This position is responsible for not only claims made by the Social Care Network to 3rd party payers (e.g. NYS), but also for processing claims made by Community-Based Organizations to the Social Care Network as a social care claims payment processor.

Essential Functions:

• Develop and manage entire revenue cycle for the 1115 Waiver Social Care Network including the member eligibility assessment process, billing, coding, collections, and denial management
• Communicate professionally with various stakeholders including, but not limited to, payers, community partners, and SCN governance
• Responsible for management and maintenance of billing function of the SCN IT Platform
• Provide up to date education for billing and coding to the SCN Finance Team as well as community-based organizations participating in the Social Care Network
• Develops, evaluates, implements, and revises policies and procedures related to billing, coding, reimbursement activities, and improvement strategies
• Reconcile all receivables and revenue reports and works closely with the Finance Department for purposes of developing monthly financial statements
• Manage and update the fee schedules based on latest New York State guidance
• Review and resolve issues related to claim generation and rejected/denied billings in eMedNY
• Commit to highest level of business and patient confidentiality possible adhering to HIPAA and security guidelines when accessing and sharing patient information
• Maintain appropriate internal controls over AR/AP activities for Social Care Network billing
• Prepares reports as required for New York State or other Payer audits and reporting requirements

MINIMUM REQUIREMENTS:

• Education: Bachelor's degree required and 3-5 years of related work experience
• Prior experience with process development and execution
• Possesses strong communication skills (written and verbal)
• Negotiation skills and the ability to develop strong working relationships
• Experience with various coding structures, including ICD-10 Z-Codes, SNOMED, LOINC, HCPCS
• Proficient in planning & time management
• Ability to work independently with minimal supervision
• Utilizes critical thinking / problem-solving skills
• Strong attention to detail
• Skilled with personal computer programs such as Microsoft Outlook, Microsoft Office (Word, Excel PowerPoint etc.) Tableau and/or PowerBI also helpful
• Facilitation of meetings either in person or via virtual platforms such as Zoom
• Preferred: The Social Care Network billing and claims function is being built on New York State Medicaid program frameworks. As such, experience with New York State Medicaid claims billing, regulations, and claims management functions is highly desired
• Preferred: Experience with ICD-10 'Z codes', SNOMED-CT, HCPCS, and NYS Modifiers

LICENSE/CERTIFICATION:

• Minimum Required: N/A
• Preferred: Certified coder, coding auditor, or coding education experience

WORK ENVIRONMENT:

Care Compass Network utilizes a hybrid work model where employees are able to work remotely from a home office or from the CCN office, a non-clinical professional office setting. There may be some travel required for partner and/or network meetings.

BENEFITS:

• Outstanding benefits package (Medical, Dental and Vision, plus much more!)
• 401(k) with match
• Competitive wages
• 14 paid holidays, paid time off (vacation, personal and sick time)