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Clinical Operations Manager
1 week ago
Forge Health is a pioneering outpatient mental health and substance use provider dedicated to delivering exceptional, affordable, and evidence-based care to individuals, families, and communities in need. With a proven track record of driving clinical outcomes, Forge Health is at the forefront of innovation, improving care delivery, and shaping the future of behavioral healthcare.
Our MissionWe are committed to providing high-quality, patient-centered care that addresses the unique needs of our community. Our team of compassionate professionals is dedicated to creating a supportive and inclusive environment where individuals can achieve their full potential.
Job Summary
The Manager (Director) of Revenue Cycle Management will lead the day-to-day operations associated with patient eligibility, charge entry, accounts receivable management, and patient invoice management. This role requires strong analytical and problem-solving skills, with the ability to interpret complex financial data and trends to develop effective revenue cycle strategies.
Key Responsibilities:
- Manage billing work inventories related to mental health and substance use disorder services with commercial health plans, state Medicaid, and managed-care organizations, and Medicare.
- Proactively identify situations requiring intervention (i.e., denials, underpayments, and other issues). Plan, prepare, and conduct corrective actions in partnership with key stakeholders.
- Make corrections to staff execution and/or business process challenges that lead to revenue collection delays.
- Ensure patient insurance eligibility is actively managed to ensure smooth billing experiences for patients and effective submissions to applicable insurance companies.
- Effectively utilize available data to identify key performance themes and trends.
- Active coaching and development of teammates as it relates to direct performance of defined objectives and professional development.
- Foster a team environment promoting performance, belonging, and engagement.
- Ensure the Revenue Cycle team executes defined processes in accordance with applicable regulations, policies, and procedures.
- Partner with leadership to develop, recommend, and implement payor contracting strategies for fee-for-service and value-based initiatives with commercial health plans, Medicaid, and Medicare partners.
- Identify and ensure revenue cycle management training needs at all levels of the organization and foster change to achieve performance improvement initiatives.
