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Manager of Revenue Cycle Management - Remote (US)

Position Type: Full-time, Exempt

Job Location: Remote (US)

Company Overview

Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical relationships. We offer a broad scope of services including multispecialty physician services, telemedicine, remote patient monitoring, and more. We currently operate primary care clinics and provide medical services to skilled nursing facilities in numerous states across the nation.

As a leading edge, innovative, and quality driven physician group, we continue to expand nationally. In pursuit of this, we continue to seek talented individuals to join our amazing team and care for our population. We wish to extend a warm welcome to all candidates interested in making a difference in healthcare delivery by joining the Theoria team

Theoria's Finance Department is seeking individuals to join its team to oversee and optimize the revenue cycle operations of our physician group. The Revenue Cycle Manager will be responsible for managing the billing and collections processes, ensuring accurate and timely submission of claims, and resolving any revenue cycle issues that arise. The candidate must have extensive experience in healthcare revenue cycle management, strong leadership and communication skills, and a commitment to maximizing revenue while minimizing operational costs.

Essential Functions and Responsibilities

• Lead and manage the revenue cycle operations, including but not limited to billing, holds/credentialing, denials, collections, and accounts receivable management.
• Assist in developing and implementing KPIs and policies and procedures to ensure accurate and timely submission of claims, reduce denials, and increase collections.
• Analyze trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff, third party vendors and revise policies and procedures.
• Identify and resolve revenue cycle issues, including coding and billing errors, incomplete or inaccurate patient information, insurance prioritization and other issues that may impact revenue.
• Monitor and analyze revenue cycle metrics, including accounts receivable aging, claim submission, payment turnaround times, and denial rates.
• Analyze billing and claims for accuracy and completeness; follow up with RCM teams and third party vendors on work queues, pending claims and unpaid AR.
• Spearhead the resolution of rejected or underpaid claims by conducting targeted appeals and payer negotiations.
• Analyze and manage overpayments from payers as well as implementing policies to reduce denials and refunds.
• Work with credentialing, billing and coding staff to ensure compliance with regulatory requirements, including HIPAA and other federal and state regulations.
• Work closely with the RCM Directors to supervise, mentor, and evaluate offshore RCM teams and third party vendors.
• Develop and maintain strong relationships with RCM Directors, HR, Clinical Operations and Credentialing departments to ensure a smooth revenue cycle operation.
• Review and respond to various payor correspondence
• Communicate with patients and clients

Requirements and Qualifications

• 7+ years of experience in revenue cycle management in a healthcare setting
• Advanced knowledge of the healthcare industry and a strong financial background
• Clear understanding of billing and collection regulatory guidelines and requirements
• Vast CPT and ICD-10 expertise
• Vast knowledge in credentialing and payor management
• Proficient background in reimbursements
• Experience in monitoring clearinghouse activity, reports, and processes
• Experience in setting up payors with EDI, ERA, and EFT processes
• Experience in managing and leading a team of revenue cycle professionals
• Strong analytical skills and attention to detail
• Excellent communication and interpersonal skills
• Ability to work in a fast-paced environment and manage multiple projects simultaneously
• Agility, strong leadership, problem-solving skills
• Ability to maintain up-to-date knowledge of technology and software including but not limited to Monday, Slack, Google suite of Applications, spreadsheets (Excel), Zoom, MS Teams, eClinicalWorks

Physical Requirements

• Must be punctual or on time and adhere to the company's Time and Attendance policy.
• Must be able to remain sitting for the majority of their shift.

Compensation and Benefits

• Competitive Compensation
• 401k with Employer Match
• Health, Dental, and Vision Insurance
• PTO and Holiday Pay
• Employer Paid Life insurance Policy
• Short and Long-Term Disability Insurance
• Company Provided Equipment
• Employee Assistance Program (EAP)

Employee must be able to perform the essential functions of this position satisfactorily, with or without a reasonable accommodation. Employer retains the right to change or assign other duties to this position.

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