RCM Referral & Eligibility Manager

TITLE: Referral & Eligibility Manager

DEPARTMENT: Revenue Cycle

REPORTS TO: Director, RCM

SALARY (65k - 75k)

POSITION SUMMARY:

The Referral and Eligibility (R/E) Manager position oversees all eligibility verification and authorization procurement activities for all service lines of the client. The position is responsible for the team’s production and the completion of designated KPIs. This position has direct report responsibilities, including administrative, development and mentorship of staff.

ESSENTIAL FUNCTIONS (Other duties may be assigned based on company needs.)
• 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 that would positively impact department staffing budgets
• 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 and implement appropriate corrective procedures to resolve
• Identify opportunities to build process and communication workflows with practice staff and/or management
• Assess new client workflow to ensure R/E processes for all service lines are built and managed
• Assist Revenue Optimization Specialist (ROS) for R/E in staying current on all payer bulletins and communicate pertinent information to staff
• Works 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

ADDITIONAL SKILLS REQUIRED
• Commitment to providing mentorship and development to staff
• Interact with the client, practice staff, patient, or other in a professional manner
• Works collaboratively with department managers, colleagues, staff, and leadership
• Demonstrates ability to prioritize and manage multiple tasks

EXPERIENCE AND REQUIRED SKILLS
• 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

RELATIONSHIPS
• Internal Contacts: Pinnacle Healthcare Revenue Solutions, all affiliated Pinnacle Healthcare Divisions
• External Contacts: Clients, Payers, Vendors,
• Direct Supervision: ROS R/E, R/E Coordinators
• Report To: Director of Revenue Cycle Management

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