Rcm Manager Jobs in Boca Raton, FL (NOW HIRING)

Revenue Cycle Management - Manager

Full-Time Fort Lauderdale, FL

LOCATION

Fort Lauderdale, FL

REPORTS TO

Chief Financial Officer & Marie Johnson, RescueMed Financial

DIRECT REPORTS

Two FTEs

REVA is the largest dedicated fixed-wing air medical transport provider, operating a jet fleet of approximately 14 aircraft. Our team of 120 members-with offices in Fort Lauderdale, FL; San Juan, Puerto Rico; Schenectady, NY; and Shannon, Ireland-has been the key to REVA's success over the past 28+ years. Following significant post-COVID growth, REVA is primed for continued expansion.

The Revenue Cycle Management (RCM) Manager provides financial, administrative, and clerical leadership to ensure the accuracy and efficiency of operations. REVA built an in-house RCM team in Q4 2021, and we are now seeking our next leader to take the department to the next level. Working alongside the Chief Financial Officer and Chief Revenue Officer, the Manager will maximize the opportunity to leverage the in-network contract utilization secured over the past 24 months.

The RCM Manager will lead two FTEs and will develop synergies with the REVA Operations Center (ROC), the hub of all inbound lead generation and sales execution for the organization. Together, the ROC and RCM teams will continue to drive growth in private-pay lead aggregation, insurance verification, hospital case-manager sales conversion, and closing rates. The role spans the full revenue cycle, from first call to final appeal collection, as outlined below.

Eligibility, Authorization & Coverage

• Verify patient benefits and eligibility.
• Obtain pre-authorization numbers and pre-certifications.
• Conduct analytical review of potential flights to determine coverage under in-network contracts and identify cost-containment opportunities.
• Negotiate available in-network contracts.
• Obtain and execute Single Case Agreements (SCA) and Guarantees of Payment (GOP).
• Manage Medicare and Medicaid enrollment and revalidations.

Billing & Claims

• Prepare CMS-1500 forms and submit clean claims to the third-party billing company.
• Rebill insurance companies and other third parties to secure payment.
• Post insurance payments to patient accounts in the billing system.
• Respond to patient billing and statement inquiries, and resolve billing complaints.

Collections & Accounts Receivable

• Own all accounts receivable activities and ensure timely cash flow.
• Direct efforts to minimize the age of accounts receivable and maximize available working capital.
• Track and report the status of delinquent accounts; perform collection actions, including patient phone contact and claim correction/resubmission.
• Review accounts for assignment, prepare information for the collection agency, and refer delinquent accounts as needed.
• Reconcile the accounts receivable ledger to ensure all payments are allocated and posted correctly.

Denials & Appeals

• Manage the claim denial process, appealing and resolving payer denials through denial-recovery acceleration.
• Prepare and submit ONN letters and file with the IDR as necessary.

Payments & Reconciliation

• Receive and process client payments, including credit card transactions.
• Process client refunds as necessary.
• Perform month-end reconciliations between the billing and sales systems.

Reporting & Analysis

• Prepare weekly health insurance analysis and date-of-service (DOS) reports, providing status updates to management.
• Recommend write-offs to management and execute approved write-offs.

Compliance & Documentation

• Maintain the strictest confidentiality and adhere to all HIPAA guidelines and regulations.
• Collaborate with the medical department on letters of medical necessity and other required documentation.
• Complete a Flight Review Checklist, verifying all necessary documents for each flight.
• Coordinate collection of needed insurance documents from the REVA Operations Center.
• Maintain and update patient admission paperwork.

Collaboration

• Partner with hospital and insurance case managers to educate them and patients on REVA's services and available coverage.

• Lift 10+ lbs.
• Work various shifts and schedules.

• 401(k) with company match.
• Group medical, dental, and vision plans.
• Employee-paid long-term disability, accidental death, and critical illness benefits.
• Paid vacation, sick days, and holidays.

• Bachelor's degree in Finance, Business Administration, Healthcare Administration, or a related field (preferred).
• Certified Denial Recovery Specialist (CDRS) certificate (preferred).
• Knowledge of medical terminology and billing/coding: CPT, ICD-10, and HCPCS.
• Minimum of 5+ years leading or managing healthcare revenue cycle departments.
• Knowledge of insurance claim processing across third-party payers, Medicare, and state and federal programs.
• Advanced proficiency in all Microsoft Office applications and medical office software.
• Medevac experience preferred (fixed-wing or rotor).