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Insurance & Revenue Cycle Manager  

Category Accounting/Finance  

The Insurance & Revenue Cycle Manager role is responsible for the design, implementation and procedures for regular processing of commercial insurance billings and the revenue cycle. This individual will ensure that the appropriate contracts with commercial insurance carriers are in place, set up in our electronic billing software, and invoices for services provided are timely billed and collected. Also, the individual will promptly research and resolve denied claims. This role requires communication with external parties, e.g. commercial and government payers, and with internal team members. Strong billing compliance experience and the ability to develop, implement and manage processes and procedures are critical.

Essential Job Functions:

  • Manages the contract negotiation process with commercial insurance carriers.
  • Maintains and reviews contracts with commercial and government payers to ensure approved billings and contract provisions and obligations.
  • Sets up payers in an electronic billing system and tests the set-up as appropriate.
  • Establishes a process to bill secondary or tertiary insurances.
  • Develops and implements processes to monitor and track the revenue cycle in order to accelerate cash collection and identify and resolve issues timely.
  • Understands and implements contractual allowances with payers.
  • Collaborates with credentialing to ensure clinical and medical staff have up to date licensures to meet commercial insurance compliance.
  • Develops and implements policies and procedures for insurance billing and revenue cycle.
  • Maintains strong communication channels with internal and external parties to ensure collaborative relationships.
  • Works with other departments to solve difficult payment matters, including claims processing and billing issues/denial rates across the revenue cycle, as well as, escalated client complaints and audits problem accounts.
  • Interacts and follows up with commercial insurance carriers as needed for coordination of credentialing and payments.
  • Verifies insurance policy benefits for new and returning clients with carriers, and confirms insurance information has been completely and accurately obtained.
  • Documents information given or received to support actions taken on insurance charges or referral issues.
  • Identifies special policy clauses or pre-existing conditions and verifies effective date of policies.
  • Educates clients and families on insurance issues, and communicates client's fiscal responsibility in a professional manner.
  • Notifies clients without third party financial benefits and directs them for financial counseling according to our policies and procedures.
  • Ensures the networks and panels operate in compliance with Company policies, certification standards, and state and federal statutes and regulations
  • Maintains the highest level of expertise regarding commercial insurance regulations, medical networks and panels including data analysis, current issues, future developments, best practices, contracting and contract management, certification standards, and legal requirements.

Position Requirements
  • Bachelor’s degree from a USDOE/CHEA accredited institution in business, health systems or equivalent field and 7 years’ experience within the field preferred.
  • Insurance & Revenue Cycle Manager has a clear understanding of and is responsible for the insurance and revenue cycle.
  • Has experience with insurance guidelines and practices, including commercial payers and government payers (Medicare, and Medicaid in North Carolina and Virginia).
  • Team player willing to learn, collaborate and share ideas.
  • Analytical, detail-oriented and mission focused.
  • Able to read and interpret complex documents including statutes, regulations, legal opinions, legal letters, medical records, medical bills, medical resource materials, claim notes, and claim data fields. Able to write clear, concise reports accurately conveying complex points. Able to effectively present information and respond to questions with managers, staff, medical providers, and others.
  • Proficiency in billing system software and Microsoft Office skills, particularly advanced Excel skills.
  • Must ensure the ability to manage highly confidential information.

Full-Time/Part-Time Full-Time  
Shift -not applicable-  
Position Insurance & Revenue Cycle Manager  
Division Administration  
Exempt/Non-Exempt Exempt  
Location Administration Raleigh  
About the Organization Easterseals UCP has been part of the fabric of North Carolina and Virginia for 75 years. We started in counties all over NC and VA filling gaps and addressing the needs of children and adults with disabilities. Our legacy organizations Easterseals NC, United Cerebral Palsy NC, and Easterseals Virginia joined forces as Easterseals UCP to intentionally work side-by-side with more than 20,000 individuals and their families, providing the broad network of services and support they need to achieve better days. Today we are affiliated with both Easterseals, Inc. and United Cerebral Palsy Inc.

Our mission is to create opportunities, promote individual choice, and change the lives of children and adults with disabilities by maximizing their individual potential to live, learn, work and play in their communities.
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.  
SuperVFlg None Specified 

HoursPerWk None Specified 

This position is currently not accepting applications.

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