Manager, RCM (Radiology)

OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.

Job Description:

The Radiology RCM Manager duties include direct personnel management of the team, participating in all radiation billing/collections functions including policies and procedure development and compliance associated with radiation oncology billing, running daily reports, performing team audits and ongoing training of the team. This position is responsible for auditing physician documentation for appropriate coding compliance and reporting this information back to management. Assist with medical record review to assure appropriate compliance. Excellent verbal and written communication skills required for reporting findings to management and physician leadership.

Responsibilities:

• Provide day-to-day supervision of front and back-end functions including authorizations, billing, and AR.
• Review/oversee photon radiation oncology charges to ensure complete and accurate capture of charges
• Review/oversee prior authorizations as required by the patient’s insurance carrier and coordinate with clinicians, hospital staff, and third-party authorization vendors in order to track and communicate authorization status.
• Review monthly AR reports to identify payer trends, issues and aged A/R and work with payors on coverage limitations related to photon radiation oncology services.
• Keeps informed regarding current coding regulations, auditing, professional standards and company/department policies and procedures as it applies to the field of radiation oncology and effectively applies this knowledge.
• Works and/or maintains accounts in AR.
• Documents collection activity in the collection notes.
• Calls on outstanding balances due from carriers and/or patients.
• Reviews and responds to incoming telephone or mail inquiries.
• Assists with third party payor and other audit requests.
• Reviews and approves write off adjustments for accounts as needed.
• Reviews and approves refund requests and sends to AP department for processing monthly.
• Routinely performs site visits for E&M and CPT coding audits and other projects related to physician coding compliance in fulfillment of the practice’s compliance program.
• Assists practice leadership to analyze data, identify issues, reach conclusions, and propose strategies for resolution of complex coding issues.
• Communicates effectively with practice leadership regarding coding and documentation issues.
• Assists practice leadership in the development and review of detailed audit programs and reports.
• Assists in developing and executing educational plans related to coding matters.
• Assists in the development of procedure manuals related to coding and billing compliance.
• Monitors and reports volume of work as well as any outstanding issues to applicable manager.
• Assess workflow and develop strategy to complete all necessary work prioritizing tasks as necessary.
• Review & approve employee time for semi-monthly payroll.
• Monitor overtime.
• Manage employee activity such as hiring, job performance, and quarterly performance reviews.
• Manage employee relations issues appropriately as they arise and escalate to manager as necessary.
• Prepare end of month report.
• Ensures up-to-date documentation on patient accounts in the Electronic Medical Record and Patient Management System.
• Maximize IT system integrations for EMR and Practice Management system.
• Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.
  
  

Required Qualifications:

• Minimum of three years healthcare management experience; preferably with Oncology/Hematology knowledge.
• Bachelor’s degree preferred.
• Basic understanding of oncology practice management preferred, in-depth understanding of insurance EOBs, CPT, ICD & HCPCS coding.
• Experience with Centricity, Unlimited Systems a plus.
• Minimum of three years Medical Coding, Chart auditing, and healthcare experience required; preferably with Oncology/Hematology with knowledge of both the front office and business office in a healthcare setting. At least 1 year of supervisory experience required.
  
  

Essential Competencies:

• Attendance is an essential job function.
• Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with physicians, patients, clinical and administrative staff, and the public.
• Excellent customer service skills with the ability to process patient and public inquiries, including complaints, and respond with poise and efficiency.
• Knowledge of clinic office procedures, prior authorizations, and medical coding.
• In depth understanding of Managed Care Organizations and payer guidelines
• Knowledge of clinic office procedures, medical practice and medical terminology.
• Ability to interpret, adapt and apply guidelines and policies and procedures.
• Ability to successfully organize, delegate, and supervise.
• Ability to recognize, evaluate and solve problems.
• Ability to successfully plan, implement and manage multiple projects simultaneously.
• Strong organizational skills and attention to detail.
• Strong knowledge of Windows-based software applications. (E.g.: Word, Excel, Outlook…)
• Excellent Customer Service skills.