Revenue Cycle Systems Manager - Los Angeles, CA
Downtown Los Angeles
Administration – Billing /
Full-Time Regular /
Hybrid
Planned Parenthood Los Angeles is seeking an experienced Revenue Cycle Systems Manager with excellent administrative skills to work in our Downtown Los Angeles Headquarters. The Revenue Cycle Systems Manager will be responsible for leading the successful implementation of revenue cycle systems and initiatives to streamline operational workflows. The Revenue Cycle Systems Manager will lead revenue cycle analysis in all department areas, including analytics and dashboard reporting to identify business trends and anomalies.
Over one hundred years ago, Planned Parenthood was founded on the idea that everyone should have the information and care they need to live strong, healthy lives and fulfill their dreams. Founded 52+ years ago, Planned Parenthood Los Angeles is one of the largest providers of reproductive health care services in Los Angeles County. The Planned Parenthood Los Angeles (PPLA) team works together to provide high-quality, affordable reproductive health care to women, men, and young people across Los Angeles County. At PPLA, you will discover a culture of like-minded individuals who are eager to make positive contributions to their community and to the Planned Parenthood mission.
Our ideal candidate will have the following qualifications:
- High school diploma or GED required. Bachelor’s degree in business, Finance, Healthcare or related field preferred.
- Certification in EPM systems preferred.
- Minimum five (5) years of experience with CMS (Medicare / Medicaid) billing regulations required.
- Five (5) to seven (7) years of experience of ICD10, CPT/HCPCS and revenue codes, CMS billing regulations and healthcare reimbursement required.
- In-depth knowledge of private and governmental insurance eligibility and verification, charge capture, CPT maintenance, coding, billing and collections, payment posting and self-pay.
- Strong knowledge of clinical practice and revenue cycle management including third-party reimbursement guidelines and procedures.
- Advanced computer skills, including proficiency in Microsoft Office and Excel
- Deep understanding / expertise of end-to-end revenue cycle operations
- Experience in process analysis, documentation, and optimization preferred.
- Minimum five (5) years of experience with end-to-end Revenue Cycle Management required.
- Minimum three (3) years of supervisory experience required.
- Ability and willingness to travel within and outside of Los Angeles County.
- Reliable means of transportation for onsite and off-site work.
- If using a personal vehicle to drive for work purposes, a valid CA driver license and current auto insurance in compliance with the minimum requirements of CA vehicle code are required.
About the position:
- Abortion patients are cared for at each of our health centers, and in part through the administrative, support, and other non-clinical services provided at all PPLA locations, and by all PPLA employees. Supporting these critical services is an essential job duty, and a fundamental responsibility of all employees and contractors.
- Manage the optimization of revenue cycle operations by implementing and analyzing systems and initiatives that enhance efficiency and identify business opportunities.
- Manage and optimize the revenue cycle processes within the organization.
- Monitor and analyze data related to the revenue cycle processes to identify opportunities for improvement.
- Collaborate with stakeholders to ensure successful implementation of revenue cycle initiatives.
- Maintain up-to-date knowledge of healthcare information systems, revenue cycle operations, and related regulations.
- Train and mentor team members on revenue cycle processes and related software.
- Develop and document policies and procedures related to revenue cycle operations.
- Monitor and report on the performance of revenue cycle systems and initiatives.
- Develop and maintain effective relationships with external vendors.
- Support the Revenue Cycle supervisory team to identify and implement solutions to the operational areas, where challenges and/or processing problems have been identified.
- Ensure the timeliness of processing and correction of rejected claims.
- Identify opportunities (e.g., reimbursable items not being charged, etc.) for charge capture and reimbursement improvement using contract and denials management tools/techniques, random reviews (including payment accuracy reviews), review of medical records and claims data.
- Report productivity metrics of Revenue Cycle staff to ensure that high productivity and proficiency standards are met. Compile monthly KPI reports to monitor key performance indicators.
- Support monitoring and follow-up to ensure timely repayment is made for all identified overpayments received from government agencies, health plans and patients.
- Ensure compliance with existing rules, new rules, regulations and revisions, as set forth by the Center for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (CA DHCS) as well as other federal and state laws and regulations that govern matters related to the revenue cycle.
- Analyze financial, productivity, performance, and quality data to identify root cause problems and define solutions to improve metrics performance.
- Serves as the backup for the system analyst for NextGen and other applications to run reports etc.
- Communicate with DHCS and other external entities on behalf of PPLA when issues are identified, and recommend action that is best for the organization.
- Assist in the monitoring and tracking of revenue cycle goals and reports inconsistencies to management team. Responsible for all Revenue Cycle Management reporting.
- Monitor and update MCSS communication log and provide updates to Revenue Cycle staff and Revenue Workgroup with changes that impact PPLA.
- Identify patterns and trends from payers and make recommendations for improvement or actions to improve PPLA position in maximizing revenue.
- Other duties as assigned by the Senior Director of Revenue Cycle and Insurance Verification and/or CFO.
Generous salary and benefits package includes:
- Medical, dental, and vision coverage options for you and eligible dependents
- Free basic life/AD&D policy with additional voluntary coverage options
- Short Term Disability, Critical Illness and Accident policies
- 403(b) Retirement plan with up to 6% employer match
- Medical and Dependent Flexible Spending Account plans
- Public Transportation and Commuter Pre-Tax Reimbursements
- Generous vacation, sick, and holiday benefits
- Hiring range of $86,000 to $103,000 (Exempt)
Compensation Philosophy and Position Hiring Range:
At Planned Parenthood Los Angeles we continuously work towards our values of Justice, Equity, Diversity, and Inclusion including with our compensation philosophy. PPLA recognizes that decisions about pay and benefits have significant impact on staff, so we are committed to ensuring all positions are rooted in a description that identifies competencies, duties, responsibilities and qualifications, and that they are compensated equitably which takes into account both internal organizational equity and market compensation data for similar roles.
Equal Employment Opportunity will be afforded to all applicants and other covered persons without regard to protected characteristics, including their perceived protected characteristic. Protected categories include: race (including traits historically associated with race, including but not limited to, hair texture and protective hair styles such as, braids, locs, and twists as examples but not exhaustive list), color, religion or religious creed (including religious belief, observation, practice, dress, and grooming practices), national origin, ancestry, physical or mental disability, medical condition, genetic information, marital status, sex (including pregnancy, childbirth, breastfeeding/chestfeeding, or related medical conditions), reproductive health decision-making, gender, gender identity, gender expression, age (40 years and over), sexual orientation, veteran and/or military status (including past, current or prospective service in the uniformed service), and any other characteristic protected under applicable federal, state or local law. PPLA will consider for employment qualified applicants with criminal histories in accordance with the requirements of Los Angeles Fair Chance Initiative for Hiring.
