Job Description

Job Description

Job Description

We are the authorized distributor of the Diabetes medical equipment Dexcom (Continuous Glucose Monitor) and Tandem (Insulin Pumps) in Puerto Rico and the Caribbean.

The Revenue Cycle Manager oversees the Concierge, Pre-Authorization, Deliveries, Inventory, Billing and Collections areas.

Core Responsibilities :

• Perform as an expert for the department on all issues relating to prescriptions orders, coding, equipment dispatch, inventory and billing.
• Oversee and participate in managing the patient financial communications, cash revenue cycle, insurance billing and accounts receivable.
• Supervise the department operations; perform duties such as charge entry, inventory management, payment posting, reimbursement management, referral, insurance verification, routes creation, equipment dispatch, claim submissions and accounts receivable follow-up.
• Oversees Inventory and audit it periodically to ensure accuracy.
• Ensure that the daily routes are coordinated and performed taking into consideration urgent requests and metrics established for the delivery of the equipment.
• Maintain strong communication and alliances with the delivery company.
• Attend meetings with insurance companies regarding billing denials, billing invoices and payment status.
• Carry out audits of current procedures and processes, discover billing operations areas to improve on and perform the necessary actions.
• Train, allocate work, and resolve problems among customer service, technical and billing office personnel.
• Measure the service provided to patients through the different channels.
• Establish performance metrics for all functions and measure them to pursue expected results.
• Quarterly, quality audits of each process area.
• Ensure quality and appropriate trainings are provided to newly hired and existing staff through effect supervision and coordination of the training process, and by adhering to established company operating policies, procedures and systems, protocols, techniques, and standards
• Carry out analysis of trends affecting coding, charges, accounts receivable, and collection, and assign manageable tasks to billing staff.
• Collaborate with other departments to get and analyze additional information about patients to be able to record and process billing effectively.
• Performance and implement Billing Guidelines, including CPT and ICD-10, changes.
• Skills in Assertus System (Pro-Claim), to achieve the 91% of Clean Claim Ratio including Prospective Billing Audit and Retrospective Billing Audits.
• Assist Operations Director in any external audits or duties related to the process.
• Ensure the billing area carries out all its activities in accordance with its overall protocol, and also that they complied with payer, State, and Federal requirements, regulations, and guidelines.
• Remain updated on HIPAA and all other health information management issues and regulations.

Key Credentials

• Bachelor's Degree in Business, Management, and/or Healthcare Administration or equivalent in knowledge and experience.
• Five (5) years of experience in a similar role.
• Strong experience in insurance/healthcare billing and collections work in a healthcare setting
• Possess profound knowledge and understanding of rules and regulations affecting billing and insurance verification.
• Deep knowledge and understanding of revenue cycle, collections and payment posting, billing, Medicaid, and third-party payers.
• Thorough knowledge and working experience of CPT and ICD-10 codes, claim forms, HIPAA, clinical terminology, appeal processes, billing and insurance regulations, and insurance benefits.
• Solid knowledge of basic accounting principles and business management to be able to effectively give direction to the billing and coding office.
• Strong negotiation skills to be able to effectively deal with insurance companies and customers and secure payment, as well as to be able to discuss the finances of patients.
• Possess current knowledge of electronic health records and their applications.
• Strong interpersonal skills to be able to effectively relate with the public, patients, organizations, and other employees.
• Strong skills in carrying out every part of the work process, i.e. development, implementation, and administration, effectively.
• Detail-oriented with the ability to work under pressure and frequent interruptions from staff and patients without being distracted.
• Strong ability to communicate effectively with staff, colleagues, patients, physicians, and insurers in person, over the telephone, and in writing.
• Strong proficiency in the use of Word, Outlook, Excel, and other Microsoft Office tools.
• Strong ability to display exceptional initiative and work under little or no supervision.
• Strong ability to train and supervise the work of employees; effectively organize, prioritize, and schedule tasks to ensure practice timelines are met.
• Strong ability to handle problems consisting of multiple variables in an organized manner.

Equal Opportunity Employer

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