What Does A Revenue Cycle Manager Do? | Enter.Health

A revenue cycle manager plays a critical role in the healthcare organization. This individual is responsible for ensuring that the financial systems are operational and effective in collecting payments from patients, insurance companies, and government programs. It can be a complex and demanding job, but it's also essential to the organization's financial health. So let's look at exactly what it entails.

What Is A Revenue Cycle Manager?

A revenue cycle manager (RCM) is a healthcare professional responsible for ensuring that a healthcare facility's billing and coding procedures are accurate and up to date. RCM’s are a relatively new position in the healthcare industry. Still, it is growing in popularity as the Affordable Care Act (ACA) has emphasized providers' need to collect payments for services rendered. 

An RCM's responsibilities vary depending on the dimensions and type of healthcare facility. Generally, they include overseeing the claims process, monitoring reimbursement rates, working with insurance companies, practicing revenue cycle management (RCM) techniques, etc.

The job market for RCMs is expected to grow significantly in the coming years as the ACA's implementation continues and more facilities begin to hire full-time RCMs. Those interested in becoming an RCM should have a strong healthcare administration and finance background.

Role Of A Revenue Cycle Manager

The healthcare field, they specialize in  revenue cycle management, which aims to manage an organization's revenue and billing cycle to enhance patient relations and maximize cash flow. Some more duties include:

Duties Of A Revenue Cycle Manager

  • Revenue cycle managers work on organizing billing and collection efforts
  • Track the activities of the accounts receivable
  • Control the monthly closing procedures, which include account balance and reporting
  • Checking patient's insurance eligibility
  • Ensure that insurance companies and patients are correctly billed
  • Document insurance company rejections of medical billing claims
  • Instructing new hires

Criteria For A Revenue Cycle Manager

  • Getting the necessary education and work experience in a healthcare institution are requirements for becoming a revenue cycle manager.
  • Bachelor's degree in business administration, accounting, or a closely related medical profession
  • 4–7 years of medical billing expertise
  • Experience in managing a bonus
  • Understanding of HIPAA rules
  • Talents in computers, analysis, and organization

Capabilities As A Revenue Cycle Manager

Successful revenue cycle managers need particular talents to address the jobs that occur. Therefore, the tracking points or qualifications for this position are:

Communication Abilities, Both Verbal And Written

Revenue cycle managers must be able to communicate with insurance companies, staff members, and patients about the billing process and stay up-to-date on current laws and regulations. Therefore, they should have verbal and written communication expertise, including public speaking and writing reports.

Work Ethic

The revenue cycle manager is responsible for the financial health of the organization. One must be diligent in your work, accurate in your record-keeping, and focused on goals. Significant work ethic is needed in RCM and these iinclude,

Punctuality

Revenue Cycle Managers must be punctual. They often work with tight deadlines and need to be able to meet them. This requires being able to arrive on time and get started right away.

Honesty And Integrity

Revenue Cycle Managers need to be honest in their dealings with customers. However, they also need to have integrity in their work. This means being able to keep confidential information confidential and not taking shortcuts.

Be Organized

This includes keeping accurate records and being able to access them quickly. It also means being able to prioritize tasks and stay on track.

Be Patient

RCM sometimes has to deal with demanding customers. They need to be patient and understand that not everyone will be happy with the transaction's outcome. They also need to be able to explain the situation clearly so that the client can make an intelligent decision.

Proactive

Being proactive means identifying problems before they happen and taking steps to prevent them. It also means acting quickly when problems occur so they can be resolved quickly.

Computer Proficiency

RCMs must be comfortable working with various computer programs and systems to manage billing records and interact with insurance companies. They should also be able to analyze data and identify billing trends to optimize the organization's revenue cycle management process.

Abilities In Financial Management

A revenue cycle manager must have strong financial management skills to manage a healthcare organization's billing, collections, and other financial aspects effectively. This includes managing budgets, analyzing data, and tracking payments.

Aptitude For Addressing Issues

The ability to locate and fix problems is crucial in this profession since revenue cycle management frequently entails finding and fixing faults with a billing department's existing procedures and policies. The technical responsibilities or errors with the billing process that RCMs must address include software bugs, misplaced records, and other similar issues.

Knowledge Of Customer

RCMs must understand their customers' needs, including patients and insurance providers. To effectively manage billing relationships with customers, revenue cycle managers need to be able to understand and anticipate their needs.

Ability To Adapt

The healthcare sector experiences ongoing change, mainly when new rules are implemented and patient requirements evolve. A revenue cycle manager may thrive in their position by having the flexibility to adjust procedures and respond to changes. The technological advancements in healthcare can also require RCMs to learn new skills and adapt to evolving requirements.

Best Practices Of Successful Revenue Cycle Implementation For Managers

Several best practices can help revenue cycle managers implement their organization's billing processes successfully. These include:

RCM Expertise And Knowledge

The key to maintaining a healthy revenue cycle is to hire a team of qualified employees. Each department must carry out specific tasks like billing, coding, or processing claims, and those in charge of these must be knowledgeable about and skilled at their respective roles.

Precision

Maintaining the RCM company's reputation depends heavily on accuracy. Clinical coding and billing are the two primary responsibilities of the RCM, and they impact the process of obtaining medical claims. Therefore, the claim processing could be significantly delayed even by a small error in these tasks.

Efficiency

Revenue cycle administration must communicate with every department to ensure the findings are 100% accurate. In addition, they must maintain effective communication inside the departments of their business and with other parties, including doctors, nurses, caregivers, hospital registration personnel, and other revenue cycle companies. This will enhance the efficiency of the organization.

EHR Innovation

The electronic health record (EHR) systematically collects patient medical transcriptions and other data. They can be distributed throughout multiple healthcare sectors via a network link. They contain the individual's personal information, pharmaceutical history, and additional medical information such as scan reports, transcripts, and so on.

Finding The Right Revenue Cycle Manager

Now that we've gone through what a Revenue Cycle Manager does, it's essential to understand the best practices for implementing these strategies in your workplace. Following the tips and criteria above can set you up for success as a Revenue Cycle Manager. 

If you need help or want to hire a revenue cycle team, visit Enter.Health or contact us today. We're always happy to chat about how we can make your job easier and help your business run smoothly.

Revenue Cycle Management

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