Job Summary:
This position exists to support the revenue cycle from the front end through the successful completion of the billing process. Manages all aspects of new hire training and on boarding to ensure successful integration of new employees with Omni RCM best practices. Supports the CFO and Sr. Director of Revenue and Finance Management with the development of strategic initiatives. Works with Information Technology, Medical, and Operations to ensure that key RCM procedures are direction to support and improve critical revenue cycle initiatives and goals. Works with the accounting and operations teams to ensure timely and accurate reconciliation of daily collections, deposits and posting in the patient accounting system. Leads the management of staff in the oversight of HRSA and other governmental agency requirements including; provider audits, health center staff performing registration functions, insurance verification and authorization processes. Partners with other Omni departments to develop structured auditing and reporting methodologies combined with follow-up and training for all staff involved in the revenue cycle process.
Job Duties:
The following statements describe the general level of work to be performed and are not intended to list all duties and responsibilities required.
- Responsible for all aspects and management of the staff located in the health centers performing, registration, insurance verification, primary provider identification, and enrollment in state funded health programs.
- Coordinates new hire training and site designation for all front office activity, including initial audit and assessments through the completion of the employee probation period.
- Manage the staff that coordinates and facilitates compliance audits, directs internal compliance reviews, and provides feedback and education to clinics.
- Supports RCM and Finance in the monitoring, tracking and reporting of daily cash flow. Constantly review and improve the process through the implementation of new technology.
- Coordinates with Managed Care department to ensure smooth implementation of new payer contracts and ensures appropriate set within the patient accounting system. Works with all departments to review and verify eligibility coverages of payer sources and other agencies and are current in the E.H.R. system and properly communicated to all District Administrators.
- Work with Information Technology and Operational leadership to identify E.H.R and other software initiatives related to workflow issues that may improve the effectiveness of the revenue cycle process. Make recommendations to implement identified solutions.
Ensures that Front office and RCM staff are trained and follow established Standard Operating Procedures to meet revenue cycle expectations.
Supports the RCM team in the absence of the Sr. Director, Revenue Cycle & Finance Management
Other related duties as required by the CFO or Sr. Director, Revenue Cycle & Finance Management.
Additional Duties:
1. HIP AA compliance - Responsible for maintaining abreast of and in compliance with all HIP AA regulations and requirements. Treats all member information confidential.
2. Compliance - Ensure compliance with all local, state and federal regulations.
3. QA/QI - Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
4. IT - Required learning and using the Electronic Health Record and Practice Electronic System and its components. As required by the job functions and highlighted in the Policies and Procedures. These components include NextGen, PMS, QSI and other electronic features, as they are developed and implemented, as applicable to work environment.
5. All employees will participate in Patient Centered Health Home Model at Omni Family Health.
Skills:
1. Must be a self-starter and able to work under pressure and handle multi-functions.
2. Analytical with ability to determine critical areas to address as well developing appropriate approach to solution.
3. Effective communicator at all levels.
4. Ability to establish and maintain effective working relationships across the health center.
5. Excellent customer service and public relations skills.
6. Knowledge of CPT/ CDT and ICD l0 codes and HCPCS coding.
7. Knowledge of all programs offered and payer codes available in Omni Family Health.
8. Knowledge of sliding fee schedules.
9. Ability to relate to the public regardless of ethnic, religious, and economic status.
Qualifications, Education, and Experience:
1. Bachelor's degree in business or healthcare management, or related field preferred.
2. Master's degree preferred.
3. 6 - 8 years Revenue Cycle & Operations Management experience with minimum of four years overall revenue cycle leadership experience. Experience working in a federally qualified health center environment preferred.
4. Certification in at least one of the following: Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Coding Specialist- Physician-based (CCS-P) or Certified Professional Biller (CPB), and/or Certified Medical Reimbursement Specialist (CMRS) credentials. Higher credentials acceptable.
5. Experience with working in an integrated healthcare model required; NextGen preferred
6. Demonstrated knowledge of all insurance companies, HMO's, PPO's, Medicare, Worker's Comp, and third party payers.
Classification: Full Time, Exempt
Reports to: Sr. Director, Revenue & Finance Management
Skills Required
- Bachelor's degree in business, healthcare management, or a related field
- Master's degree
- 6–8 years of revenue cycle and operations management experience
- At least four years of revenue cycle leadership experience
- Certification as CCA, CCS, CCS-P, CPB, CMRS, or a higher credential
- Experience working in an integrated healthcare model
- Experience in a federally qualified health center environment
- Experience with NextGen
- Knowledge of insurance companies, HMOs, PPOs, Medicare, Workers' Compensation, and third-party payers
- Knowledge of CPT, CDT, ICD-10, and HCPCS coding
- Knowledge of payer codes and sliding fee schedules
- Ability to use electronic health record and practice management systems
What We Do
Omni Family Health is a national award-winning network of state-of-the-art Community Health Centers. Omni provides quality healthcare services throughout California's Central Valley, in Kern, Kings, Tulare, and Fresno counties. Our organization is committed to meeting the healthcare needs of our local communities by providing a healthcare delivery system that offers a full range of primary, preventative care, and supportive services in medical, dental, behavioral health, pharmacy, and many more specialties. As a mission-driven organization, Omni's team of committed providers and staff promote accessible, affordable, quality health care for patients of all ages and backgrounds, regardless of a patient's ability to pay. Omni accepts most insurance plans; however, medical insurance is not required to receive services. Medi-Cal, Medicare, and Denti-Cal are accepted forms of healthcare coverage. Omni offers free interpretation services at our health centers. Omni’s achievements have been nationally recognized by numerous organizations, including the Migrant Center of the Year and the Outstanding Achievement Award, both issued by the National Association of Community Health Centers. Most recently, Omni received consecutive 2017 and 2018 HRSA Quality Improvement Awards for exceeding national clinical quality benchmarks. Joint Commission and Patient-Centered Health Home accreditation demonstrate Omni's best-practice healthcare delivery system. The impressive accomplishments of the organization can be attributed to the leadership of the Board of Directors, the dedication of the Executive Management Team led by Chief Executive Officer, Francisco L. Castillon, MPA, and the ongoing commitment of staff. To fulfill Omni’s mission and vision, the organization will continue to strive to be the leading healthcare organization throughout the Central Valley and beyond.
