Revenue Cycle Systems Manager

at Exact Sciences (view profile)
Location Madison, Wisconsin
Date Posted March 29, 2019
Category Medical Testing
Job Type Full-time
Address 441 Charmany Drive


Summary of Major Responsibilities

The Revenue Cycle Systems Manager works closely with the Exact Sciences Laboratories Data Integrity Specialists and File Maintenance Specialists in oversight of the Revenue Cycle Management System (RCM). The Revenue Cycle Systems Manager is responsible for all systems related to the RCM, including oversight of all health system revenue related interfaces and processes to ensure timely and accurate claim submission and remit processing and accounts receivables. This role will be responsible for system and system related process configuration to support Exact Sciences Laboratories revenue cycle.

Essential Duties and Responsibilities

  • Develops and oversees processes and procedures for the efficient and successful flow of interdependent information between the third-party billing vendor, the receivables department and Exact Sciences contact center.
  • Develops processes and policies for system configuration and utilization.
  • Works directly with Client Support and Implementation Services (CSIS) team to ensure accurate and timely client implementations as concerns the revenue cycle.
  • Monitors RCM and initiates appropriate escalation or corrective measures as needed.
  • Ensures that customer satisfaction is achieved through courteous and effective communication, problem solving and efficient processes.
  • Resolves complex patient, physician and other client issues when applicable.
  • Promotes a team-oriented environment that fosters effective collaboration within and outside of the department.
  • Monitor payor and contractual configuration and payor specific claim requirements.
  • Monitors all RCM processes to ensure compliance with performance metrics.
  • Proactively identify and assess trends and aberrations within the RCM and proposes course of action.
  • Maintains confidentiality in compliance with HIPAA regulations and ensures that department remains compliant with all relevant regulations.
  • Monitors payor and client master files to ensure accurate and timely updates or changes.
  • Investigate and resolve electronic remittance errors.
  • Monitor error reports and resolve issues that relate to billing file maintenance including but not limited to payor interface errors, system related eligibility error messages, and manual pricing releases.
  • Work closely with vendor and payor partners to identify and resolve systematic issues.
  • Ensure compliance with all Company procedures and guidelines including but not limited to Code of Business Conduct and Ethics. Stay current with relevant guidelines and policies for medical billing.
  • Monitor reason code files to ensure accurate and timely updates or changes.
  • Oversee maintenance and updates regarding software vendor changes.
  • Provide systematic support to ensure timely electronic submission of claims including subscriber ID format, Z-code requirements, etc.; based on payor and contractual requirements.
  • Routinely audit system updates (e.g. payor, client, reason code, letter content, etc.) to ensure data integrity of the billing system.
  • Support and comply with the company’s Quality Management System policies and procedures.
  • Regular and reliable attendance.
  • Ability to work normal schedule of Monday through Friday during normal business hours.
  • Ability to work in front of a computer screen and/or perform typing for approximately 80% of a typical working day.


Minimum Qualifications

  • Bachelor’s degree or Associate’s degree with 2 years of professional experience.
  • 5+ years of experience working in the medical/healthcare billing area, with strong, demonstrated knowledge of managing IT systems.
  • Thorough understanding of medical billing processes.
  • Deep familiarity with payer/insurance appeals and reimbursement processes.
  • Demonstrated knowledge and familiarization with Medicare billing regulations and reimbursement methodologies.
  • Strong analytical and forecasting skills.
  • Experience working with a third-party billing service provider or revenue cycle management software.
  • Strong organizational and problem-solving skills.
  • Adaptable, open to change and able to work in ambiguous situations and respond to new information and unexpected circumstances.
  • Strong interpersonal and teamwork skills including the ability to easily convey concepts and priorities as well as ability to solicit feedback and inputs.
  • Strong presentation skills with ability to convey information and adjust delivery as appropriate to the audience.
  • Demonstrated ability to inspire and motivate others and work effectively through influence and collaboration.
  • Demonstrated ability to successfully manage multiple priorities/projects at one time and ability to handle pressure of deadlines and complex issues in an effective way.
  • Demonstrates analytical skills and critical thinking abilities (i.e. to identify payor payment inconsistencies or other issues proactively; to comprehend billing ledgers of charges, payments and adjustments.).
  • Demonstrated ability to create and maintain logs/charts in an accurate, organized and effective manner.
  • Demonstrated expertise using Microsoft Excel.
  • Authorization to work in the United States without sponsorship.

Preferred Qualifications

  • Leadership in accounts receivable or billing operations.
  • Experience working in the insurance industry.
  • CPC, CPAM or similar certification is encouraged.
  • Membership in any of the patient accounting organizations (e.g. AHAM) is encouraged.
  • Membership in any of the industry organizations (e.g. HFMA) is encouraged.

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