Centrum Health

Centrum Health

Manager, Revenue Cycle Management

Doral, Florida, United States

Sponsorship not specifiedDetected 1 day ago
Data AnalysisComplianceExcelAuditingVendor ManagementHIPAAEHR/EMRICD-10Patient CareLeadershipCommunicationCollaborationProblem SolvingMentoringPublic SpeakingMicrosoft OfficeAccounts Payable

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About the role

  • By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
  • We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally.
  • This role is responsible for the back-end revenue cycle, including claims adjudication, denial management, appeals, payment posting, accounts receivable, and reimbursement reconciliation.

Responsibilities

  • Manage, monitor, and reconcile the fee-for-service (FFS) billing vendor to ensure submissions, payments, and performance meet contractual and internal expectations.
  • Implement and maintain a proactive management system to ensure payments are posted accurately and on time and that no claim goes unworked.
  • Assume additional tasks, projects, and responsibilities as needed to support leadership and enterprise priorities.
  • Develop, implement, and maintain revenue-cycle policies and procedures to ensure accuracy, consistency, and efficiency.
  • Analyze rejection and denial trends, identify root causes, and implement corrective actions and prevention strategies.

Requirements

  • Minimum of five (5) years' experience in billing or revenue cycle management, with at least two (2) years in a supervisory role.
  • Familiarity with CMS guidelines and payer-specific billing requirements.
  • Strong knowledge of the full revenue cycle - charge capture, claim submission, rejections/denials, payment posting, accounts receivable, and reconciliation.
  • Working knowledge of ICD-10-CM, CPT, and HCPCS as they relate to clean claims and revenue integrity.
  • Familiarity with clearinghouses, ERA/remittance processing, and practice-management / billing systems.
  • Proficiency in calculating percentages, adjustments, and account balances accurately.
  • Ability to analyze financial data to reconcile discrepancies and identify areas for improvement.
  • Strong problem-solving skills and the ability to apply sound judgment to standardized and complex situations.
  • Advanced proficiency in Microsoft Excel (pivot tables, formulas, and data analysis) and Microsoft PowerPoint (executive-level presentations), with strong working proficiency
  • To perform this job successfully, an individual must meet the following qualifications. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
  • Certifications & Licensure
  • Required
  • Certified Revenue Cycle Representative (CRCR)
  • Equivalent revenue cycle experience may substitute for certification
  • Active certification must be maintained in good standing through AAPC, AHIMA, HFMA, or an equivalent credentialing body, including required continuing education units (CEUs).
  • Preferred
  • Certified Professional Coder (CPC)
  • Certified Risk Adjustment Coder (CRC)
  • Certified Professional Medical Auditor (CPMA)

Nice to have

  • Bachelor's degree preferred
  • Experience with Medicare Advantage, ACA/Exchange, and Medicaid revenue cycle preferred
  • FFS billing and vendor-management experience strongly preferred.
  • Bilingual proficiency in English and Spanish preferred.

Benefits

  • Monitor and manage the revenue cycle once claims leave the door - tracking rejections, denials, appeals, and payment posting through to resolution.
  • Oversee revenue-cycle training for the medical centers and ensure processes are correct, consistent, and compliant.
  • Establish, monitor, and improve revenue cycle performance metrics including denial rates, clean claim rates, accounts receivable aging, reimbursement accuracy, and cash collections.

Company info

  • NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
  • NeueHealth delivers clinical care to health consumers through our owned clinics - Centrum Health and Premier Medical - as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.
  • The Manager of Revenue Cycle Management oversees revenue cycle operations across Centrum's medical centers, including Ponsol and Neighborhood Health, ensuring accurate reimbursement, regulatory compliance, and financial integrity across Medicare Advantage, ACA/Exchange, and Medicaid lines of business. This role is responsible for the back-end revenue cycle, including claims adjudication, denial management, appeals, payment posting, accounts receivable, and reimbursement reconciliation.
  • The Manager develops and oversees revenue cycle processes to ensure timely claim resolution, accurate payment posting, effective accounts receivable management, and compliance with CMS, state Medicaid, HIPAA, and payer-specific requirements. The role also manages the fee-for-service (FFS) billing vendor, monitors performance against established standards, and implements controls to ensure claims and payments are accurately processed and reconciled.
  • NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care.
  • NeueHealth delivers clinical care to health consumers through our owned clinics - Centrum Health and Premier Medical - as well as unique partnerships with affiliated providers across the country.
  • Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.
  • The Manager of Revenue Cycle Management oversees revenue cycle operations across Centrum's medical centers, including Ponsol and Neighborhood Health, ensuring accurate reimbursement, regulatory compliance, and financial integrity across Medicare Advantage, ACA/Exchange, and Medicaid lines of business.
  • The Manager develops and oversees revenue cycle processes to ensure timely claim resolution, accurate payment posting, effective accounts receivable management, and compliance with CMS, state Medicaid, HIPAA, and payer-specific requirements.
  • The role also manages the fee-for-service (FFS) billing vendor, monitors performance against established standards, and implements controls to ensure claims and payments are accurately processed and reconciled.
  • Working in partnership with Finance, Operations, Medical Coding, and Medical Auditing, the Manager drives revenue integrity initiatives, supports clean-claim performance, improves reimbursement outcomes, oversees revenue cycle education for clinic leadership, and ensures effective collection of copays and point-of-service balances.
  • This position also resolves complex payer and patient billing issues and performs other duties as assigned in support of departmental and organizational financial performance
  • This position carries revenue cycle responsibility across all Centrum centers (including Ponsol and Neighborhood Health), with primary ownership of the post-submission cycle, and is expected to operate cross-functionally and flexibly as organizational needs evolve.
  • The scope of the role includes, but is not limited to, the following:
  • Monitor and improve charge capture processes in partnership with Coding, Operations, and Clinical leadership.
  • Work closely with Finance and center managers to ensure copays and point-of-service balances are collected.
  • Safeguard revenue integrity - ensuring charges, codes, and claims are complete, accurate, and compliant across all centers.
  • The following responsibilities are representative of the work performed in this role.
  • Other duties may be assigned as organizational needs and regulatory requirements evolve.
  • Revenue Cycle Operations & Oversight
  • Direct revenue cycle operations with primary ownership of the post-submission cycle: claim rejections, denials, appeals, payment posting, and accounts receivable.
  • Monitor claims from submission through adjudication and payment, resolving rejections and denials promptly to minimize revenue leakage.
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