Revenue Cycle Accounts Receivable, Senior Manager - Los Angeles, CA

Our Ideal Candidate will have the following qualifications:

• High school diploma or GED required. Bachelor's degree in Business, Finance, Healthcare or related field preferred.
• Coding certification required.
• Auditing certification preferred.
• Five (5) years of experience with revenue cycle operations management required.
• Five (5) years of coding and/or audit experience preferred.
• Thorough understanding of CMS (Medicare / Medicaid) billing regulations.
• Minimum eight (8) years of experience with ICD10, CPT/HCPCS and revenue codes, CMS billing regulations and healthcare reimbursement.
• In-depth knowledge of private and governmental insurance eligibility and verification, charge capture, CPT maintenance, coding, billing and collections, payment posting and self-pay.
• Strong knowledge of clinical practice and revenue cycle management including third-party reimbursement guidelines and procedures.
• Minimum five (5) years of supervisory experience required.

About the position:

• Abortion patients are cared for at each of our health centers, and in part through the administrative, support, and other non-clinical services provided at all PPLA locations, and by all PPLA employees. Supporting these critical services is an essential job duty, and a fundamental responsibility of all employees and contractors.
• Complete Quality Reviews (QR) of Accounts Receivables Aging, perform daily Continuous Quality Improvement reviews to provide insight into trends and timely feedback to the Revenue Cycle Supervisory team, staff, and Senior Director of Revenue Cycle and Insurance Verification.
• Lead the Revenue Cycle supervisory team to identify and implement solutions to the operational areas, where there are difficulties and/or processing problems.
• Provide guidance to Revenue Cycle Supervisors regarding Account Receivable reviews, troubleshooting, and resolving complex account problems.
• Monitor daily reconciliation dashboard and or reports (e.g., missing charges reports, late charges, etc.) that assist managers and supervisors in maintaining accurate and timely charges.
• Ensure the timeliness of processing and correction of rejected claims.
• Identify opportunities (e.g., reimbursable items not being charged, etc.) for charge capture and reimbursement improvement using contract and denials management tools/techniques and implement processes to improve and maintain areas of need
• Conduct audits (including but not limited to payment accuracy reviews), audit of medical records and claims data.
• Report productivity metrics of Revenue Cycle staff to ensure that high productivity and proficiency standards are met. Compile monthly KPI reports to monitor key performance indicators.
• Perform monitoring and follow-up to ensure timely repayment is made for all identified overpayments received from government agencies, health plans and patients.
• Conduct work plan reviews and document results; implement corrective action plans as required.
• Create and maintain an effective undercharging monitoring and response program. Research and propose fee schedule optimization opportunities to mitigate reimbursement losses.
• Ensure compliance with existing rules, new rules, regulations and revisions, as set forth by the Center for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (CA DHCS) as well as other federal and state laws and regulations that govern matters related to the revenue cycle.
• Review changes in pricing, CPTs, HCPCs, rev codes, etc. for accuracy and compliance with all applicable charging and billing guidelines. Ensure teams stay informed of payor and/or regulatory updates and create action plans to accommodate changes as needed.
• Manage direct report(s) to include but not limited to overseeing successful completion of tasks / duties, review of timesheets in a timely manner, setting productivity goals & quality of work output expectations by exercising effective judgment and addressing and/or elevating grievances (staff concerns), as appropriate.
• Adhere to PPLA’s policies and procedures for interviewing / selecting new hires, promotions, transfers, performance management and separations.

Generous salary and benefits package includes:

• Medical, dental, and vision coverage options for you and eligible dependents
• Free basic life/AD&D policy with additional voluntary coverage options
• Short Term Disability, Critical Illness and Accident policies
• 403(b) Retirement plan with up to 3% employer match
• Medical and Dependent Flexible Spending Account plans
• Public Transportation and Commuter Pre-Tax Reimbursements
• Generous vacation, sick, and holiday benefits
• Hiring Range: $104,683 - $125,620 annually (Exempt)