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Incomplete applications will not be evaluated. Only complete applications will be considered for the position.
For consideration of any position we require a fully completed application. This includes Education Information, Employment History and Work Experience. Account for all employment within the last ten years, beginning with your current or most recent employer. In addition, indicate any other experience which you feel is relevant to the position for which you are applying (military experience, volunteer or experience gained etc.). If the field is not applicable, mark N/A. Please attach your resume as supplemental information only. Applications will be rejected if “SEE RESUME” is written on any portion of this section
The Revenue Cycle lead position is under the direct supervision of the Billing/Coding Director.
The incumbent is responsible for activities related to the organization’s revenue cycle, including billing, accounts receivable management, collections, system and EDI payment clearing house administration. This is a lead role, which also entails making recommendations for revenue optimization and coaching other staff as necessary to realize organizational revenue and compliance objectives.
MAJOR DUTIES AND RESPONSIBILITIES:
• Understands, analyzes and synthesizes all revenue cycle activities to identify payer trends & patterns, including accounts receivable management,
billing, collections and writeoffs, denials management, and credit balance reconciliations.
• Develops and executes on a revenue cycle plan to optimize revenue and productivity.
• Responsible for managing, coordinating, and implementing all edits to the Master Fee Schedule and ensuring that reimbursements conform to contract
• Implements annual price increase and coordinates Medicare, DHCS, Managed Care and IPA fee updates.
• Ensures that all NextGen Practice Management, Payer, Provider Credentialing, and Pricing configurations are in place and current to make certain that
the organization is positioned to obtain all reimbursements according to entitled contract rates.
• Analyzes and resolves specific billing edits and/or errors that are delaying claims from processing in the NextGen Practice Management system.
• Provides oversight and management of all clearinghouse functions and processes, including ad-hoc reporting as necessary.
• Manages NextGen projects encompassing all phases of application/technology implementations and updates
• Works closely with Information Systems, ensuring that NextGen Practice Management workflows function appropriately
• Evaluates processes with NextGen, eMedApps and/or other vendors to determine possible changes needed within billing and coding operations.
• Routinely reviews and audits clinic billings and collections to ensure timely billing and maximum collections according to insurance contracts, and
proactively identifies risks and problems impacting clinic cash flow.
• Reviews, analyzes and codes clinic diagnostic and procedural information that determines appropriate insurance payments.
• Makes recommendations relative to compliance concerns related to Billing, Coding and Fees practices.
• Manages collections activity for all payers. Ensures that payer accounts receivable remains current or that a collection and follow up plan is in place for
material past due balances.
• Promptly communicates any areas of concern related to revenue cycle or compliance to the Director of HIM-Billing Coding for further escalation or
• Works closely with RSBCIHI Healthcare staff in all departments to identify and correct problem areas negatively affecting reimbursement
• All other duties as assigned by Director of HIM & Billing and Coding and or Chief Financial Officer
• Other duties as assigned
Education & Experience
Applicant must possess a High School diploma or equivalent, Certified Coder Specialist (CCS), AHIMA Certified or Certified Professional Coder (CPC) required and Certified Physician Biller (CPB) – AAPC Certified Preferred.
Diverse understanding of revenue cycle, including credentialing, provider enrollment, billing, collections, payment/adjustment posting, credit balance/refunds, statements, bad debt write offs, collections processes and reporting.
Stays abreast of industry standard changes and regulations relevant to reimbursement for the Medicare, Medicaid, Managed care, and commercial payers
Must have a clear understanding of third-party regulatory requirements including Medicare, Medicaid, Managed Care and Commercial Payers
Provide assistance and train as needed all Coder/Billers
Skill to effectively work with all levels of health system personnel
Must demonstrate customer service skills appropriate to the job
Extensive Knowledge of ICD-10-CM, CPT, HCPCS and revenue codes
Knowledge of coding software tools to maintain current charging and billing guidelines
knowledge and ability essential to the successful performance of assigned duties
Must be able to work with the Indian Community, and be sensitive to the Indian Culture and its needs.
Excellent written and verbal communication skills
The physical requirements that the job might entail.
You are also advised that this organization is required to give preference in employment and training to qualified Indian candidates (Title 2 U.S. Code 472 and 473) and Public Law 93-638 provided the applicant has submitted appropriate verification of Indian preference for employment.
NOTICE OF DRUG-FREE WORKPLACE ENVIRONMENT:
Riverside-San Bernardino County Indian Health Inc., has adopted a Drug-Free and Alcohol-Free Policy, in part, to satisfy its obligations under the Drug-Free Workplace Act of 1988. It is unlawful for any employee to manufacture, distribute, dispense, possess or use a controlled substance in the workplace. In addition, Riverside-San Bernardino County Indian Health, Inc., must be notified within five (5) calendar days of any criminal drug statute conviction for a violation occurring in the workplace. Employees who are suspected of violating Riverside-San Bernardino County Indian Health, Inc.’s Drug-Free and Alcohol-Free Policy may be required to submit to inspections of their persons, vehicles or personal property. This may include medical testing for alcohol and/or drug use.
ADDITIONAL JOB DETAILS:
Salary Range: $58,240-$68,640
Medical, Dental and Vision to all Full-Time Employees
Paid Time Off, Extended Illness Time
Paid Time off for Bereavement and Jury Duty
401(k) – Retirement Programs
Life Insurance- 2 Times Your Annual Pay (Limit Applies)
Long Term Disability
Supplemental Benefits- Accident, Critical Illness, Life, Short Term Disability
Employee Assistance Programs
Employee Fitness Program
Tuition Reimbursement Program for Native American Employees
Career Advancement Opportunities
Information on working hours, shifts, and expected attendance.
San Manuel Indian Health Clinic (11980 Mt. Vernon Ave. Grand Terrance Ca, 92313)
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