CHW Revenue Cycle Management Billing & Coding Manager

Coastal Health & Wellness is Galveston County’s Community Health Center, with clinics in Texas City and Galveston.  We also service TCISD students and employees.  First established in 1970 and then called Galveston County Coordinated Community Clinics (4C’s), we provide high quality healthcare to all - offering primary care, prenatal, dental, and behavioral health counseling services. 

RCM provides task-based coding, billing, and collection support to CHW and various Galveston County Health District (GCHD) partners. This includes standard, highly reliable, team-oriented, daily work with payors including Medicare, Medicaid, Medicaid Managed Care, Commercial Insurance as well as County Indigent and Self-pay patients in NextGen EPM/EHR/EDR.

The CHW Revenue Cycle Management Billing & Coding Manager will have financial and operational accountability over CHW’s revenue capture system, including but not limited to, claims, coding, prior authorization, verification of benefits, accounts receivable, and all other revenue cycle operations. This individual will provide leadership, administration, supervision, organization, planning and direction over all activities of the Revenue Cycle to ensure accomplishment of the organization's objectives leading CHW medical, dental, and behavioral health billing and coding functions for all outpatient professional services to ensure its compliance, accuracy, and timely submission for payment.  Additionally, they are accountable for the planning, development, deployment and maintenance of a highly reliable coding audit and education program via coaching of staff, physicians, nurses, and other departments.  This leader serves as the principal liaison with The Board, providers, executive team, and managers related to day-to-day medical, dental and behavioral health RCM activities.   The CHW RCM team is responsible for compliant, comprehensive, and critical work in areas including but not limited to medical, dental and/or behavioral health pre-authorization, eligibility & benefits, coding, claims submission, A/R follow-up, payment posting & reconciliation, denial management and customer service. 

We can offer you:

• Excellent Benefits; including an Amazing retirement package, Paid Time Off plans, Affordable Medical Insurance, FREE Life Insurance, FREE Long-Term Disability, FREE Parking and much more!
• Team Oriented Environment
• Salary Rate: $62,400.00 actual offer will be commensurate upon related experience & education

We want you to join our team of professionals!  If you meet the criteria listed below, please apply.

Required:

• Certifications:
  • Certified Professional Coder (CPC) required.
  • Certified Professional Medical Auditor (CPMA), Certified Medical Office Manager (CMOM), Certified Professional Biller (CPB), preferred.
  • Certified Documentation Expert Outpatient (CDEO) or Certified Risk Adjustment Coder (CRC) a plus.
• Bachelor’s Degree plus a minimum of five (5) years of coding experience in private physician and/or FQHC organization to include three (3) years coding supervisory/management progressive leadership experience.
• Proven ability in coding compliance program development, deployment, and oversight.
• Knowledge of coding/billing regulatory requirements.
• Excellent interpersonal, presentation and written communication skills.
• Bilingual in Spanish preferred.
• NextGen EPM, EHR, EDR experience is preferred.
• Strong leader who intentionally invests in the development of others and identifies/closes knowledge gaps.
• Capable & competent time management and multi-tasking acumen.
• Understanding of medical terminology and coding & billing compliance laws, regulations, policies, and guidelines.
• Customer experience-oriented professional with demonstrated performance history and commitment.
•  Advanced skills Microsoft suite of products; Outlook, MS Office (MS Excel & MS Word) – SharePoint experience a plus.

• Must be compliant with GCHD Immunizations policy and ICS training requirements.
• Must pass criminal background check and drug/alcohol screening.
• Must be willing and able to work evening and weekend hours, as necessary.

• Must possess or ability to readily obtain a valid driver’s license issued by the State of Texas for the type of vehicle or equipment operated.
• Department of Motor Vehicle check may be required, if applicable.

An equivalent combination of education and work experience which appropriately demonstrates the knowledge, skills and abilities to perform the above described essential functions will be considered when hiring for this role. 

Traditional Duties:

• Direct supervision of RCM Supervisor.
• Provides direction and manages the day-to-day functions within the RCM team which include medical, dental, and behavioral health encounters for uninsured as well as claims with all payors including Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies.
• Manages staffing plans and work assignments to achieve and maintain established productivity thresholds.
• Establishes and monitors the performance aligned with billing and coding to support accurate patient information, compliant coding aligned with billing regulations, building strong front-end edits to avoid corrections and re-work.
• Manages and monitors daily work activities, NextGen tasks, worklists and evaluates, trains, and motivates the performance of RCM staff.
• Promotes recruitment, retention and succession planning of RCM staff with a deliberate focus on educating and training, acting as a professional subject matter expert and mentor.
• Proactively develops, updates, and enforces RCM policies & procedures, conducts trend analysis to identify patterns and variations – bringing solutions to bare.
• Delivers comprehensive reporting to The Board, leadership, providers, and other stakeholders that communicates relevant trends, KPIs, and analytical insight into performance.
• Assists RCM Director in departmental budget and identifies and recommends opportunities to decrease cost and improve services and experience for patients and other stakeholders.
• Stays up to date with current technology, coding updates & opportunities, billing, payer requirements and federal and state regulations related to FQHC billing, coding, and collections.
• Manages, trains, and educates staff as it pertains to payor requirements and back-end denial denials; reviewing, coordinating, and monitoring the denial management and appeals process.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports organizational strategy and goals; serving as preceptor, mentor, and resource for less experienced staff.
• Manages staff and helps staff develop performance, training goals and objectives. Evaluates performance and recommends merit increases, promotions, and disciplinary actions to Human Resource Officer.
• Analyzes the cost benefit of programs. Synchronize processes, systems, policies and workflows across Registration, Prior Authorization, Coding, Accounts Receivable and Coding & Billing for best throughput, best practices, and efficiency.
• Communicates with cross-functional, internal & external teams to identify & resolve billing and/or payment issues.
• Oversees incoming calls, portal inquiries, askRCM, NextGen tasks, emails and other correspondence related to patient accounts by deploying active listening. Answers patient questions on patient responsible portions, co-pays, deductibles, write-offs, etc.
• Maintains patient confidentiality and protect GCHD/CHW operations by keeping patient information confidential.
• Prepares and ensures accuracy of all reports to management, consultants, payors, and other 3rd parties, as appropriate.
•  Leads by example, serves as a key contact and supports enterprise-wide projects and initiatives that relate to strategic priorities, health care legislation and compliance, systems redesign, integrations, revenue optimization, and cost reduction.

• Acts as a back-up to other RCM team members and actively initiates and leads RCM projects & blitzes.
• Attends all staff in-services, provider meetings, workshops, and training, leads as appropriate.
• Exercises independent judgment based on CHW Policy and compliant billing & coding best practice.
• Performs other duties as assigned.

No Phone Calls Please

ADA/EEO/DFWP

Our Mission: Protecting and Promoting the One Health of Galveston County