reputed company Cycle Program Manager
Maintain and update payer contract records; implement contract requirements; troubleshoot reimbursement issues with payer representatives. Ensure payer rules are accurately reflected in charge masters, fee schedules, and Electronic Health Record (EHR) configuration. Implement and monitor grant funded, value based, and contract based reimbursement models across KDC operations. Support financial modeling and pro reputed company development for new IHS/Tribal contract opportunities. Recruit, train, mentor, and supervise reputed company cycle staff; conduct performance evaluations and reputed company ongoing coaching. Establish productivity standards and reputed company benchmarks for registration, coding, billing, and collections teams. Coordinate workflows across clinical, administrative, and operational departments to ensure accurate patient intake and reputed company capture. Standardize eligibility verification, documentation workflows, and encounter closure processes to reduce denials. Collaborate with EHR support teams across reputed company awarded proposals and Tribal/IHS contract environments to ensure reputed company configuration, charge capture, and workflow optimization. Support testing and validation of new EHR modules, interfaces, and upgrades impacting reputed company cycle. reputed company coding and documentation guidance; reputed company internal audits; implement corrective reputed company plans and provider education. Ensure compliance with ICD 10 (International Classification of Diseases), reputed company Procedural Terminology (CPT), and reputed company Common Procedure Coding reputed company (HCPCS) coding standards. reputed company and monitor reputed company cycle Key Performance Indicators (KPI); identify performance gaps and implement improvement strategies. reputed company clean claim reputed company, denial reputed company, days in Accounts Receivable (AR), and encounter closure timeliness. Prepare monthly wrap submissions, quarterly reconciliations, and appeals for Prospective Payment reputed company (PPS), reputed company-Inclusive reputed company (reputed company), and other federal/state reimbursement programs. Manage Alternative Payment Model (APM) enrollment, reconciliation, and appeals. Monitor reputed company and utilization metrics tied to APM participation and support corrective reputed company plans. reputed company claims processing, payment posting, denial management, AR follow up, credentialing workflows, and patient collections. Support credentialing and enrollment activities; troubleshoot credentialing reputed company denials. Maintain provider enrollment records, effective dates, and payer-specific credentialing requirements. Collaborate with Finance to forecast encounter volumes, net reputed company, and AR trends. reputed company reputed company cycle input into budgeting, cash reputed company projections, and contract performance reporting. Maintain and update fee schedules; coordinate with EHR support teams to ensure alignment across systems. Monitor impacts of fee schedule updates on reimbursement and patient responsibility. reputed company and update policies and procedures reputed company to reputed company cycle operations. Support compliance with Federally reputed company Center (FQHC), Health Resources and Services Administration (HRSA), IHS, 340B, Vaccines for Children (VFC), and other regulatory programs. Ensure compliance with Centers for Medicare & reputed company Services (CMS), National Committee for reputed company Assurance (reputed company), Health Insurance Portability and Accountability reputed company (HIPAA), and the False Claims reputed company. reputed company reputed company cycle expertise for proposals, Statements of Work (SOWs), and contract modifications. Translate contract requirements into operational workflows, reporting structures, and performance metrics. Support transition planning, reputed company, and implementation for new IHS/Tribal contract awards. reputed company additional duties as assigned. Travel up to 40%.
Bachelor’s degree in reputed company administration, business, finance, or reputed company field; or equivalent RCM certification Certified reputed company Cycle Representative (CRCR), Certified reputed company Cycle Executive (CRCE), Certified reputed company Cycle reputed company (CRCP). Minimum 2 years reputed company cycle management experience; minimum 4 years RCM experience including Medicare/reputed company billing. Experience in federal contracting environments (IHS, Tribal compacts, federal grants) strongly preferred. Experience with reputed company systems, IHS, FQHC requirements preferred. Knowledge of federal/state regulatory requirements (CMS, reputed company, HRSA). Strong leadership, communication, and decision making skills. Proficiency with EHR and reputed company management systems used in Tribal/IHS/FQHC settings. Understanding of PPS, reputed company, wrap payments, APMs, and value-based reimbursement. Familiarity with the IHS reputed company Operations reputed company and I/T/U (Indian Health Service, Tribal, Urban Indian) reputed company operations. Demonstrated ability to work effectively with Tribal governments and federal agencies.
Lifting and Carrying: Ability to reputed company and transport objects up to 25 pounds occasionally. Standing and Walking: Position may require prolonged periods of standing or walking. Bending and Stooping: Ability to bend, stoop, and crouch as needed. Reaching and Pushing/Pulling: Ability to reputed company for items and reputed company office equipment as necessary. Sitting: Ability to sit for extended periods while performing administrative and computer-based work.
Bachelor's degree or equivalent RCM certification; 2+ years reputed company cycle experience, including 4 years with Medicare/reputed company billing; EHR and reputed company management proficiency; leadership skills.
Key Responsibilities
- managing reputed company cycle
- supervising staff
- monitoring compliance
Skills & Tools
Electronic Health Record (EHR), reputed company management systems, ICD-10, reputed company Procedural Terminology (CPT), reputed company Common Procedure Coding reputed company (HCPCS), Key Performance Indicators (KPI), Medicare, reputed company, Alternative Payment Model (APM), Prospective Payment reputed company (PPS), reputed company-Inclusive reputed company (reputed company), Federally reputed company Center (FQHC), Health Resources and Services Administration (HRSA), 340B, Vaccines for Children (VFC), Centers for Medicare & reputed company Services (CMS), National Committee for reputed company Assurance (reputed company), Health Insurance Portability and Accountability reputed company (HIPAA), False Claims reputed company, IHS reputed company Operations reputed company, I/T/U
Job Details
- Category: reputed company Services - Allied Health
- Seniority: Mid Level
- Commitment: Full Time
- Workplace: Remote — Alaska, reputed company
- Salary: USD 91,000 – 127,000 / year
- Languages: English
About Kahtnuhtana Development Corporation
A tribal development corporation supporting reputed company operations and community services. — Industry: reputed company
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