Job Title: RCM - Lead Location: Remote Job Summary: We are seeking an experienced Senior RCM Manager to oversee and optimize the Revenue Cycle Management (RCM) process within the US healthcare industry. The role involves managing claims, insurance reimbursements, provider credentialing, and accounts receivable (AR) using Tebra software. The successful candidate will lead a team and ensure the organization's financial health by maintaining compliance, enhancing efficiency, and maximizing revenue. Key Responsibilities: - Revenue Cycle Management Oversight: Lead the complete RCM process from patient registration through payment resolution. Utilize Tebra software to manage billing, claims, and accounts receivable. Optimize RCM metrics such as Days in AR, collections, and claim denial rates. - Provider Credentialing and Enrollment: Manage the credentialing and enrollment process for providers with Medicare, Medicaid, and private insurance companies. Ensure that all provider information is up-to-date and compliant with payer requirements. Collaborate with providers and payers to streamline the credentialing process and avoid delays in reimbursement. - Eligibility and Benefits Verification: Oversee the eligibility and benefits verification process to ensure accurate and timely verification of patient insurance coverage. Coordinate with insurance providers to confirm patient benefits and avoid claim rejections due to coverage issues. Train staff on the verification process and troubleshoot escalated issues related to coverage discrepancies. - Claims and Billing Management: Ensure the accurate submission of claims and the resolution of denied or rejected claims in a timely manner. Implement strategies to reduce denials and rejections while improving claim acceptance rates. Work closely with insurance providers to resolve billing disputes and ensure proper reimbursements. - Accounts Receivable (AR) Management: Monitor and manage the AR process to maintain a low Days in AR and improve collections. Develop strategies to ensure timely payments from patients and insurance companies. Conduct regular reviews of AR reports and collaborate with the billing team to address any outstanding accounts. - Team Leadership and Development: Lead, mentor, and manage a team of billing & Enrollement. Provide training and support to ensure the team is up-to-date on RCM processes, Tebra software, and industry best practices. - Compliance and Audits: Ensure compliance with federal and state healthcare regulations, including HIPAA, CPT, ICD-10, and payer-specific guidelines. Conduct regular internal audits to maintain accuracy in billing, credentialing, and AR processes. Collaborate with compliance officers and management to address audit findings and implement corrective actions. - Reporting and Analysis: Generate detailed financial and operational reports using Tebra software to track RCM performance. Analyze trends in claims, AR, credentialing, and verifications to identify opportunities for process improvements. Provide data-driven insights and recommendations to senior management on improving revenue and reducing costs. Required Skills and Qualifications: Bachelor's degree. 7+ years of experience in RCM within the US healthcare industry. Strong experience with provider credentialing, enrollment, eligibility verification, and accounts receivable management. Proficiency in Tebra software for billing and RCM. Expertise in US healthcare insurance systems (Medicare, Medicaid, and private payers). Knowledge of CPT and ICD-10 coding, as well as HIPAA compliance. Demonstrated leadership experience managing RCM teams and processes. Excellent analytical, communication, and organizational skills

Remote

Moms'belief - RCM Lead 

Job Description for Moms'belief - RCM Lead  in Moms'Belief in  Remote for (10-15) years of experience. Apply Now!