Clinical and Pathological Laboratory RCM Manager

Who are we?

For more than 26 years, CorePlus has provided Puerto Rico with anatomical pathology laboratory services and clinical analysis with innovation and precision. Our commitment is, to be a leader in the transformation of pathology to the digital world.

In 2020 we deployed our digital pathology platform, being the first organization in Puerto Rico to make the transformation. Known worldwide for operationalizing the use of Artificial Intelligence (AI) in the diagnosis of prostate and breast cancer, CorePlus stands out for being avant-garde.

If innovation and compassion appeal to you, we invite you to join our mission and become part of our family; we offer excellent benefits including health plan, dental, vision, 401k, paid vacation, and life insurance.

The Position

The Healthcare Revenue Cycle Management (RCM) Department Manager is responsible for leading and managing a Clinical and Pathological Laboratory RCM department, which handles the health insurance billing and collecting revenue for medical services. The RCM Manager oversees the entire RCM process, from scheduling appointments and verifying insurance eligibility, from coding and submitting claims, to following up on unpaid charges and resolving denials. The RCM Manager ensures that the RCM department operates efficiently and effectively, complying with regulatory requirements and optimizing financial performance.

Responsibilities:

• Supervise, train, and evaluate the RCM staff, including coders, billers, collectors, and front-desk personnel
• Develop and implement policies and procedures for the RCM department, ensuring alignment with organizational goals and industry standards
• Monitor and analyze key performance indicators (KPIs) and metrics for the RCM department, such as days in accounts receivable, claim denial rate, collection rate, and net revenue
• Identify and resolve issues and bottlenecks in the RCM process, implementing corrective actions and preventive measures
• Collaborate with other departments, such as clinical, IT, and finance, to ensure coordination and integration of RCM activities
• Ensure the RCM software and systems are continuously maintained and updated, ensuring data accuracy and security
• Prepare and present reports and recommendations on the RCM department's performance, trends, and opportunities for improvement
• Stay abreast of the latest developments and best practices in the RCM field, such as coding changes, payer policies, and regulatory updates
• Lead the onboarding process of new clients as required

Required Skills:

• Excellent communication and interpersonal skills, with the ability to lead and motivate a team
• Strong analytical and problem-solving skills, with the ability to use data and metrics to drive decision making
• Proficient in RCM software and systems, such as electronic health records (EHR), practice management (PM), and billing software
• Knowledgeable in medical coding, billing, and reimbursement processes, rules, and regulations
• Detail-oriented and organized, with the ability to manage multiple tasks and prioritize deadlines
• Customer-oriented and professional, with the ability to handle patient inquiries and complaints effectively

Qualifications:

• Bachelor's degree in healthcare administration, business, finance, or related field
• Minimum of 5 years of experience in healthcare RCM, with at least 2 years of supervisory or managerial experience
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) credential preferred
• Experience in working with various payers, such as Medicare, Medicaid, and commercial insurance
• Experience in working with various healthcare settings, such as laboratories, hospitals, clinics, and physician practices
• Knowledge in clinical laboratories and anatomic pathology practices preferred

Working Conditions/ Physical Activity:

• While performing the duties of this job, the employee is regularly required to talk and listen.
• The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
• The employee is occasionally required to sit; climb or balance; and stoop, kneel, crouch or crawl.
• The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Syndeo, LLC is an equal employment/affirmative action opportunity employer. It does not discriminate against any qualified person on the basis of sex, race, color, national origin, religion, sexual orientation, age, marital status, mental, physical or sensory disability, or any other classification protected by applicable local, state, federal, and/or international law.