Surgical Center Revenue Cycle Operations Manager

Manager, Surgical Center Revenue Cycle Operations

Job Summary: The Manager of Surgical Center Revenue Cycle Operations is responsible for overseeing and managing all aspects of the revenue cycle for the surgical center. This includes billing and collections functions, with a specific focus on outpatient billing. The ideal candidate will manage all revenue cycle operations, from pre-estimation of patient costs to the resolution of accounts receivable. This role requires identifying and resolving payor and provider issues that impact financial viability, tracking staff productivity, monitoring the aging of charges, and handling patient complaints.

Essential Responsibilities:

• Oversee daily operations for the surgical center team, providing direct support to the Assistant Director.
• Manage the surgical center's revenue cycle team, which includes training, task assignment, performance monitoring, and providing employee support and guidance.
• Develop and implement best practices and protocols for the center's billing and collections workflows.
• Manage the center's charges, including the reconciliation of implant logs for charge entry staff.
• Obtain purchase orders and invoices for implants to submit to insurance companies.
• Work directly with payors and health plans to resolve revenue cycle issues.
• Ensure daily tracking and reconciliation of all surgical center cases.
• Monitor daily aging, tracking, and productivity of both insurance and patient-responsible accounts receivable.
• Prepare monthly and quarterly financial reports on the center's billings and collections, as well as other relevant revenue cycle metrics.
• Generate recurring and ad hoc reports for the Assistant Director of Revenue Cycle Operations.
• Assist and communicate with internal departments to address revenue cycle issues.
• Interact with outside practices and vendors to resolve billing, patient, and payor-related issues.
• Handle escalated complaints and resolve complex claims, appeals, and reconsiderations, while guiding staff on next steps for resolution.
• Manage staff disciplinary issues and escalate them to the Director as needed, collaborating with Human Resources on employee relations matters.
• Maintain comprehensive knowledge of all compliance policies and procedures related to insurance billing, reimbursement, and HIPAA regulations.
• Perform other duties and projects as assigned.

Skills and Abilities:

• Knowledge of ICD and CPT Outpatient Coding principles and guidelines.
• Understanding of government and commercial reimbursement regulations.
• Familiarity with federal payor, managed care, and third-party payor policies related to outpatient surgeries.
• Strong analytical and critical thinking skills.
• Proven leadership and management experience.
• Excellent technical skills.
• Expertise in collections and reimbursement for medical services.
• Strong written and verbal communication skills.
• Thorough knowledge of HIPAA and other consumer regulations for medical billing.
• Ability to be a collaborative team player.

Experience and Education:

• Bachelors degree and/or five years of direct management experience in a healthcare environment.
• Proficiency in Microsoft Office products (Excel, PowerPoint, Word).
• Knowledge of HIPAA and compliance laws related to Protected Health Information (PHI) within an Electronic Medical Record (EMR).
• Preferred: Certified Outpatient Coder (COC) certification.
• Minimum of two years of direct experience in medical coding.

We are an equal opportunity employer and comply with all applicable federal, state, and local fair employment practices laws. We strictly prohibit and do not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex, sexual orientation, gender (including gender identity and expression), marital or familial status, age, physical or mental disability, perceived disability, citizenship status, service in the uniformed services, genetic information, height, weight, or any other characteristic protected under applicable federal, state, or local law. Applications from members of minority groups and women are encouraged.

Pay:$62,000.00 - $70,000.00