Surgical Center Revenue Cycle Operations Manager
- North Haven, CT
- $62,000-70,000 per year
- Permanent
- Full-time
- Oversee daily operations for the surgical center team, providing direct support to the Assistant Director.
- Manage the surgical center's revenue cycle team, which includes training, task assignment, performance monitoring, and providing employee support and guidance.
- Develop and implement best practices and protocols for the center's billing and collections workflows.
- Manage the center's charges, including the reconciliation of implant logs for charge entry staff.
- Obtain purchase orders and invoices for implants to submit to insurance companies.
- Work directly with payors and health plans to resolve revenue cycle issues.
- Ensure daily tracking and reconciliation of all surgical center cases.
- Monitor daily aging, tracking, and productivity of both insurance and patient-responsible accounts receivable.
- Prepare monthly and quarterly financial reports on the center's billings and collections, as well as other relevant revenue cycle metrics.
- Generate recurring and ad hoc reports for the Assistant Director of Revenue Cycle Operations.
- Assist and communicate with internal departments to address revenue cycle issues.
- Interact with outside practices and vendors to resolve billing, patient, and payor-related issues.
- Handle escalated complaints and resolve complex claims, appeals, and reconsiderations, while guiding staff on next steps for resolution.
- Manage staff disciplinary issues and escalate them to the Director as needed, collaborating with Human Resources on employee relations matters.
- Maintain comprehensive knowledge of all compliance policies and procedures related to insurance billing, reimbursement, and HIPAA regulations.
- Perform other duties and projects as assigned.
- Knowledge of ICD and CPT Outpatient Coding principles and guidelines.
- Understanding of government and commercial reimbursement regulations.
- Familiarity with federal payor, managed care, and third-party payor policies related to outpatient surgeries.
- Strong analytical and critical thinking skills.
- Proven leadership and management experience.
- Excellent technical skills.
- Expertise in collections and reimbursement for medical services.
- Strong written and verbal communication skills.
- Thorough knowledge of HIPAA and other consumer regulations for medical billing.
- Ability to be a collaborative team player.
- Bachelor’s degree and/or five years of direct management experience in a healthcare environment.
- Proficiency in Microsoft Office products (Excel, PowerPoint, Word).
- Knowledge of HIPAA and compliance laws related to Protected Health Information (PHI) within an Electronic Medical Record (EMR).
- Preferred: Certified Outpatient Coder (COC) certification.
- Minimum of two years of direct experience in medical coding.