WVSOM Health is seeking a Revenue Cycle Manager.
Position Purpose:
This position is responsible for overseeing all aspects of the revenue cycle, ensuring efficient and accurate billing, coding, claims processing, and collections. This role focuses on optimizing revenue capture, minimizing denials, and ensuring compliance with healthcare regulations and payer requirements.
Position Qualifications:
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Associate’s or bachelor’s degree in health care administration, management, or a related business discipline preferred.
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Proficiency in Microsoft Office Suite (Excel, Word, Outlook) is required.
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Excellent written and verbal communication skills.
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Ability to manage multiple priorities.
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Strong attention to detail.
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Demonstrated leadership skills.
Experience:
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Minimum of five years of experience in healthcare revenue cycle operations and management.
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Experience using electronic health record (Athena) and practice management software is required.
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Knowledge of HIPAA regulations and rural health clinic billing practices.
- At least one year of experience supervising staff.
Licenses/Certifications: Coding certification (Certified Professional Coder – CPC or Certified Coding Specialist - CCS) is highly preferred.
Reports to: Director of Finance
Supervises: Billing department
Job Requirements:
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Manage the end-to-end revenue cycle process, including coding, billing, collections, and payment posting.
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Develop and implement policies and procedures to improve revenue cycle efficiency and reduce claim denials.
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Monitor key performance indicators (KPIs) related to revenue cycle management, including days in accounts receivable (A/R), denial rates, and collection percentages.
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Confirm deposits for payments from payers based on Explanation of Benefits (EOBs).
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Oversee clearing account activity to ensure accurate reconciliation of payments and adjustments.
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Manage postings and revenue reporting to ensure financial accuracy.
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Manage and evaluate payor contract’s annually to ensure proper compliance and align with fee setting policies and procedures.
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Update fee schedules in accordance with contract changes and reimbursement rates.
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Participate in financial audit preparations and cost report activities.
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Collaborate with the Director of Patient Services and the Patient Services Supervisor to ensure all necessary information is accurately collected during patient registration and scheduling processes, including eligibility verification and front-end Point of Service (POS) collections such as copays, deductibles, and co-insurance.
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Ensure accurate coding and documentation for all services rendered, working closely with billing staff and providers.
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Stay up-to-date with regulatory changes (e.g., Medicare, Medicaid, commercial payers) and ensure compliance with industry standards such as HIPAA and CMS guidelines.
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Conduct audits and provide training to staff to maintain accurate coding and billing practices.
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Act as a resource for complex billing issues and collaborate with providers, staff, and external entities to resolve challenges.
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Monitor healthcare industry updates from carrier websites, newsletters, and funding entities; implement changes as needed.
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Oversee the submission of clean claims and ensure timely follow-up on unpaid or denied claims and manager holds.
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Analyze denial trends and implement corrective actions to prevent recurring issues.
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Collaborate with insurance companies to resolve disputes and maximize reimbursement.
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Supervise collection efforts to ensure effective accounts receivable management and minimize outstanding balances.
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Oversee the sliding fee discount program, ensuring compliance and proper implementation.
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Direct provider credentialing and enrollment with payers, ensuring timely approval and maintenance of provider records.
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Manage provider enrollments in Athena, ensuring all required information is submitted and updated.
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Work with the Physician Hospital Organization (PHO) to ensure proper provider participation and credentialing compliance.
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Serve as the primary revenue cycle contact for Athena.
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Work with clearinghouses and third-party vendors to ensure smooth claim submission and payment processing.
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Supervise and train revenue cycle staff, ensuring accountability and efficiency.
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Work closely with providers, administration, and finance teams to align revenue cycle processes with clinic goals.
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Prepare financial reports and present revenue cycle performance data to leadership.
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Perform other duties as assigned.
All employees are required to adhere to WVSOM Health's high standards of customer service excellence.
Disclaimer:
Job descriptions are not intended and do not create employment contracts. WVSOM Health maintains its status as an at-will employer. Employees can be terminated for any reason not prohibited by law. All job descriptions have been reviewed in an attempt to illustrate the jobs functions and basic duties, in addition to ‘peripheral tasks’ or that could generally be considered ‘other duties as assigned.’ In no instance, however, should the duties, responsibilities and requirements be interpreted as all-inclusive. Additional functions and requirements may be assigned by supervisors as deemed appropriate. Requirements, experiences, qualifications, knowledge, skills and abilities have been determined to illustrate the minimal standards required to successfully perform the position.
About Us:
WVSOM Health is a Rural Health Clinic accredited by the NCQA as a Patient-Centered Medical Home - Level 3. WVSOM Health, located in historic Lewisburg, WV, offers Quality Healthcare...Close to Home.
We are located on the campus of the West Virginia School of Osteopathic Medicine (WVSOM). As a comprehensive not-for-profit health care organization, we are committed to providing quality primary health care to the residents of the greater Greenbrier Valley and surrounding areas. In addition to serving the local communities, WVSOM Health serves as a primary clinical training site for WVSOM students, interns, and residents. We offer a wide range of primary care services, including medical acupuncture, diabetic education, acute care, family medicine, psychology, internal medicine, osteopathic manipulative medicine, pediatric medicine, proctology, mental health, and radiology.
Employment at WVSOM Health is contingent upon the timely and successful completion of a post-offer drug screen, U.S. Citizenship and Immigration Service’s I-9 form, and background investigation including but not limited to whether you have been sanctioned or excluded from participating in any Medicare, Medicaid, or other government-funded programs.
WVSOM Health is an Equal Opportunity Employer.
