Function:

Reporting to the Director of Accounting Operations, the Revenue Cycle Manager is responsible for managing the Billing functions performed by our third-party billing partners, they will also act as a liaison between Fenway Health and our third-party partners to advocate for and hold both sides accountable for timely issue resolution and performance with the goal of maximizing billing collection rates and timely receipt of payment.

Representative Duties:

Liaison with Third-Party Billing Partners

• Manage and refine the customer service workflow between Fenway Health and our Third-Party Billing Partners ensuring requests are being monitored and timely resolved.
• Facilitate regular communication and collaboration to address issues, resolve discrepancies, and optimize revenue cycle performance for both medical and pharmacy operations.
• Monitor the claims processing workflow for medical and pharmacy operations to ensure accurate and timely adjudication of claims, resolution of discrepancies and denials, monitoring of the provider credential process, ensuring timely receipt of payments and the accounts receivable balances are managed.

Revenue Cycle Analysis

• Manage and refine the customer service workflow between Fenway Health and our Third-Party Billing Partners ensuring requests are being monitored and timely resolved.
• Facilitate regular communication and collaboration to address issues, resolve discrepancies, and optimize revenue cycle performance for both medical and pharmacy operations.
• Monitor the claims processing workflow for medical and pharmacy operations to ensure accurate and timely adjudication of claims, resolution of discrepancies and denials, monitoring of the provider credential process, ensuring timely receipt of payments and the accounts receivable balances are managed.

Technology and Reporting

• Key analytics user of Epic EHR system and ComputerRx (formally WinRx) pharmacy management system.
• Conduct data queries and analysis within each system to extract relevant information and identify trends, patterns, and insights related to revenue cycle performance.
• Utilize data visualization tools and techniques to regularly present findings and tell a compelling story to department owners and senior management that informs decision-making and drives revenue cycle improvements.

Billing and Coding Management

• Collaborate with clinical and administrative staff to accurately capture and ensure all billable services and procedures are documented within the chargemaster.
• Conduct periodic audits and assessments of the chargemaster to identify discrepancies, errors, or inefficiencies, and implement corrective actions as needed.
• Be a key contributor in our periodic review and update of the chargemaster
• Stay informed about changes in healthcare regulations, payer policies, and coding standards, and ensure compliance with all relevant guidelines and requirements.

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field
• Minimum of 5 years of experience in healthcare revenue cycle management, preferably in a Federally Qualified Health Center (FQHC) or other healthcare setting
• Strong understanding of healthcare billing, coding, reimbursement, and regulatory requirements.
• Ability to work harmoniously and effectively with colleagues, patients, clients and vendors across the spectrum of diversity, including but not limited to race, ethnicity, color, gender identity, sexual orientation, age, socio-economic status, national origin and immigrant status, religious or spiritual identity, disability (physical, mental, emotional and developmental), veteran status, and/or limited English proficiency.
• Willingness to contribute towards Fenway's efforts in becoming an anti-racist organization and promoting a culture dedicated to ongoing development in service of humility, equity, diversity, inclusion, and belonging, where differences are acknowledged and valued.

Preferred Qualifications:

• Proficiency in Epic EHR system and ComputerRx pharmacy management system
• Certified Professional Coder (CPC), Certified Revenue Cycle Professional (CRCP), or other relevant certifications
• Strong project management skills.