Revenue Cycle Manager

OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer. Our team is bringing together leaders to the market place to help drive OneOncology's mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.

Job Description:

The Revenue Cycle Manager BPO Oversight, is a dynamic and pivotal role designed to support practice partners within the One Oncology platform in optimizing and managing their Revenue Cycle Operations (RCM). In this position, you will lead and oversee our BPO Revenue Cycle teams, focusing on proactively monitoring key performance indicators (KPIs), identifying root causes of issues, troubleshooting problems, and developing strategies to improve metrics. This role is essential for driving a reduction in denials and increasing initial clean claims. As a member of the RCM leadership team, you will work closely with multiple departments and offshore vendors.

This position offers the opportunity to play a significant role in optimizing revenue cycle processes, fostering cross-functional collaboration, and contributing to the overall success of the organization. Join us in our mission to improve the lives of those living with cancer.

Responsibilities:

• Revenue Cycle KPI Management: Drive practice RCM KPIs to meet or exceed established targets.
• Denial Prevention: Develop and implement strategies using system functionality and billing edits to prevent denials.
• Payer Relationship Management: Establish long-term relationships and lead through influence with key payer resources to reduce Practice AR.
• Issue Identification & Troubleshooting: Troubleshoot billing and payer issues by analyzing denials, aging AR, and payer feedback to resolve problems promptly.
• Payer & Regulatory Knowledge: Stay up to date with national payer guidelines, local payer requirements, and coding and billing regulations to guide RCM teams in best practices.
• Root Cause Analysis & Process Improvement: Identify trends and root causes that contribute to aging AR, and develop proactive solutions and process improvements to address them.
• Claim Process Familiarity: Understand payer policies regarding corrected claims, payer portals, appeal levels, and timely filing limits.
• Reporting & Presentation: Prepare detailed slides and reports for Practice and Executive-level leadership.
• Training Development: Create training materials, process maps, and step-by-step guides for OneOncology practices and vendors.
• Collaboration with Analytics Team: Partner with the analytics team to develop meaningful RCM metrics and conduct in-depth reviews.
• Quality Assurance Oversight: Manage the Quality Assurance program to ensure adherence to organizational standards and processes.
• Best Practices Development: Design best practices for resolving patient AR, including pre- and post-visit workflows, and process improvements to address AR buildup quickly.
• Stakeholder Engagement: Foster strong relationships with key stakeholders at partner practices to understand their billing processes and system capabilities.
• Team Collaboration: Work closely with other members of the RCM leadership team to ensure smooth operations.
• Physician Interaction: Interface with physicians to address any billing or RCM-related issues as needed.
• Vendor & In-House RCM Compliance: Ensure compliance with all coding and billing guidelines by external vendors and in-sourced RCM teams.
• Matrix Environment: Manage multiple, often competing customer demands in a matrix environment.
• Attention to Detail: Maintain a high level of attention to detail when troubleshooting issues, analyzing claims, and reviewing process improvements.
• Other Duties: Perform additional duties as assigned to further the mission of improving the lives of individuals living with cancer.

Key Competencies

• Communication Skills: Strong ability to communicate operational workflows and issues to practice leadership, BPO teams, and key stakeholders across various levels.
• Analytical & Troubleshooting Skills: Excellent ability to analyze accounts and claims to determine root causes of issues and troubleshoot effectively.
• Advanced Excel Skills: Proficiency in advanced Excel functions for data analysis and reporting.
• Appeals & Escalations Experience: Proven experience with billing/AR escalations, including managing payer escalations and writing appeals (1st and 2nd levels).
• Clinical Understanding: Ability to comprehend clinical concepts that may lead to AR buildup (e.g., Medical Record requests and payer rationale).
• Payer Knowledge: Comprehensive understanding of billing, collections, and working with various payer types (government, managed care, private, and third-party insurance).
• Coding Knowledge: Thorough knowledge of ICD10, CPT, HCPCS, and coding guidelines; oncology-specific experience preferred.
• Multitasking: Ability to handle multiple projects simultaneously and prioritize tasks effectively.

Qualifications:

• Education: Bachelor's degree or equivalent healthcare-related experience required.
• Experience: Minimum of 7 years of experience in a management position within healthcare revenue cycle operations, with a strong understanding of end-to-end revenue cycle processes.
• RCM Expertise: Extensive knowledge of revenue cycle operations, with a deep understanding of RCM KPIs, denial management, payer relations, troubleshooting, and process improvement.
• System Knowledge: Familiarity with OncoEMR, Centricity/G4 a plus.
• Flexibility: Ability to work a flexible schedule, including evenings and weekends, as needed.
• Travel: Some travel required.

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