Revenue Cycle Manager

Position Overview

Tia is dedicated to transforming women's healthcare by improving access to and the experience of preventive services. Our model integrates primary care, mental health, gynecology, dermatology, and wellness services, treating women as whole individuals. Through a blend of in-person and virtual care, Tia's "Whole Woman, Whole Life" model aims to deliver higher quality, lower cost healthcare, making women healthier, providers happier, and strengthening the business of care delivery.

Role Summary

The Revenue Cycle Manager oversees Tia's entire credentialing process and the back-end revenue cycle, from claim rejection/denial or remittance receipt through to payment posting. This role involves leading a team to ensure providers are effectively managed through credentialing and enrollment, and collaborating with market partners to ensure correct contract setup. The manager will be responsible for establishing repeatable and optimal systems and operating procedures for provider enrollment and contract setup, as well as identifying and troubleshooting issues. Additionally, this role leads the back-end billing and revenue cycle functions, creating clear policies and delineating responsibilities between internal operations and the patient accounting system vendor. The goal is to ensure claims are paid quickly, accurately, and at expected rates, identifying and diagnosing issues as they arise. This position will also develop and track key performance metrics to ensure team operations align with organizational excellence.

Key Responsibilities

Team Leadership

• Lead a team of credentialing specialists and billing leads, providing guidance, coaching, and direction to foster a collaborative, high-performance culture within the function.

Performance Metrics

• Establish and monitor Key Performance Indicators (KPIs) to measure the effectiveness and efficiency of the billing and credentialing team.
• Analyze performance metrics and implement initiatives to achieve and exceed organizational targets.

Identifying & Resolving Areas of Revenue Leakage

• Identify and resolve potential areas of revenue leakage within the revenue cycle.
• Utilize a strategic and data-driven approach to analyze financial processes, proactively identifying gaps and implementing targeted solutions.
• Collaborate with cross-functional teams to ensure the seamless integration of initiatives.

Rejections and Denials

• Lead a dedicated team focused on minimizing rejections and denials by implementing robust operations for claims submission and validation.
• Develop and implement measures to address rejections, reduce denials, and optimize the claims process to maximize reimbursements.
• Utilize reporting and analytics to identify patterns and implement actionable solutions.

Underpayments (Incorrect Payments)

• Establish a process to identify underpayments and review payment discrepancies.
• Work with stakeholders to ensure all payments align with contractual agreements and fee schedules.

Payment Posting / Lockbox Management

• Ensure accurate and timely recording of payments, specifically virtual credit cards and checks from our lockbox system, in our patient accounting system and data.

EDI / EFT Enrollment

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