RCM Referral & Eligibility Manager
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Referral & Eligibility Manager overseeing eligibility verification and authorization procurement activities for service lines. Managing team production, quality, and resolving issues within compliance standards.
Responsibilities:
- Oversee all eligibility verification and authorization procurement activities for all service lines
- Responsible for the team’s production and the completion of designated KPIs
- Manage the R/E process to ensure that the avoidable denial percentages are within acceptable ranges
- Review and interpret monthly denial reports to identify areas of opportunity
- Monitor staff for compliance of the organization’s confidentiality policy in accordance with the Health Insurance Portability and Accountability Act (HIPAA) regulations
- Seek opportunities for automation and/or disruption in the traditional methods to reduce denials
- Ensure staff production, quality and compliance is maintained to company standards by assigning tasks to staff and monitoring to ensure performance
- Identify and resolve problems and inconsistencies
- Identify opportunities to build process and communication workflows with practice staff and/or management
- Assist Revenue Optimization Specialist (ROS) for R/E in staying current on all payer bulletins and communicate pertinent information to staff
- Work with ROS to design, implement or evaluate staff training and performance measurement criteria
- Recruit, interview and select new employees with assistance from human resources
- Responsible for supervising assigned staff, including attendance, paid time off, payroll, training, corrective action and performance evaluations
- Develop work schedules according to budgets and workloads
- Complete all tasks assigned by the Director in a timely manner
Requirements:
- 5 years of experience in revenue cycle management firm or billing office or medical practice
- Proven experience with management of staff
- Practicing knowledge of the entire revenue cycle including, intake, charge entry, accounts receivable, cash application, customer service, and credentialing
- Demonstrate knowledge of government and managed care program as well as industry terms
- Ability to maintain HIPAA as well as other compliance requirements
- Proven analytical skills
Similar Jobs
Branch Manager
Branch Manager overseeing day-to-day sales operations in Indianapolis, focusing on performance and team management. Collaborating with senior leadership to achieve operational goals and service quality.
Total Rewards Manager – Executive Compensation
Total Rewards Manager focusing on executive compensation strategies at Supercell. Partnering with leadership to evolve pay design and ensuring competitive practices globally.
Bioinformatics Team Manager
Bioinformatics Team Manager leading a senior team at DNAstack to shape bioinformatics function. Collaborating with product and engineering leadership to define the bioinformatics roadmap.
Manager – Sustainability Consulting
Manager for Sustainability Consulting at a Climate Tech Start-up supporting companies in emission reduction. Focus on carbon management and team leadership in a remote setup.
Offering Manager
PS Offering Manager managing Fortinet professional services portfolio for Exclusive Networks. Driving sales integration and vendor relationships for a global cybersecurity specialist.
PS Offering Manager
Offerings Manager overseeing Palo Alto Networks professional services portfolio management. Driving sales transformation and managing compliance as part of Exclusive Networks’ global services offering.
Offering Manager
PS Offering Manager responsible for Fortinet Networks professional services at Exclusive Networks. Leading product management, vendor relationships, and sales integration globally.
Payments Operations Manager
Payments Operations Manager leading operational excellence within Conduent's Payment Services Group. Requires strong experience in financial services and leadership skills.
Manager de Conciliación y Automatización
Manager de Conciliación y Automatización en fintech 100% remota. Liderando eficiencia y control en procesos operativos y transaccionales en Latam.
Regional Practice Manager
Regional Practice Manager overseeing the operations of infusion centers in NJ & PA. Leading clinical teams and ensuring high standards of patient care within our organization.
Gerente de Negócios
Gerente de Negócios managing client relationships and sales cycles in technology solutions. Focused on the industrial and retail segments with teamwork across internal support departments.
Enterprise Account Manager
Enterprise Account Manager driving new business sales and account rebuilding for security solutions. Collaborating with internal teams to exceed revenue targets in Switzerland and Austria region.
Channel Manager
Channel Manager responsible for driving sales through channel partners in the DACH market for AAEON. Focused on developing partner relationships and ensuring sales metrics are met.
USA PRO, Channel Manager
Channel Manager for breeder sales focusing on efficiency and profit growth at Farmina. Leading sales teams and strategies in the pet breeder channel with extensive travel involved.
Junior Area Manager
Junior Area Manager at Dyson responsible for sales strategies and retailer communication in Bavaria. Focusing on marketing strategies and training for product promotions.
Manager, Billing Analytics
Manager of Billing Analytics driving high-quality reporting to support reimbursement operations. Collaborating with cross-functional teams to improve operational performance at Veracyte.
Manager, Cloud and Data
Manager of Cloud and Data leading scalable data infrastructure at Outrider. Overseeing team mentoring and maintaining zero-emission autonomous vehicle technology operations.
Care Manager – Virtual Cardiac Rehab, Contract
Care Manager responsible for managing patients in a virtual cardiac rehabilitation program. Collaborating with teams to improve patient health outcomes and reduce cardiovascular risks.
Regional Clinical Manager – West Region
Regional Clinical Manager for VytlOne overseeing pharmacy quality and execution at health center pharmacies. Providing education, consultation, and support to pharmacy teams for optimal performance.
General Manager, USCAN – US Central East
General Manager leading Illumina's strategic direction in Central East region. Driving market success and supporting local markets across multiple states.