Revenue Cycle Manager

Department Overview

The Chancellor of the University of California, San Francisco (UCSF) through the Dean of the School of Medicine at UCSF (UCSFSOM) established the SFGH Clinical Practice Group (CPG) and delegated to the CPG the authority to negotiate and manage managed care and third party contracts for clinical services at SFGH. The Clinical Practice Group (CPG) Business Office is responsible for all aspects of the UC physician's professional fee billing and 

managed care activities at San Francisco General Hospital. This includes all 24 SFGH departments and one off­site clinic. The Business Office processes a total number of 678,000 line charges per year consisting of $240M in billed charges.

Job Function Summary

Involves revenue cycle functions for the healthcare enterprise, including system billing, reporting and support. Ensures account information contains accurate and comprehensive data to provide timely billing and optimal reimbursement for services. Impacts processes to include charge capture, coding, insurance identification, data entry, billing, payment posting, refund processing and collections. May also be responsible for / integrated with business office operations.

Generic Scope

Spends the majority of time (50% or more) achieving organizational objectives through the coordinated achievements of subordinate staff. Establishes departmental goals and objectives, functions with autonomy. Manages the accountability and stewardship of human, financial, and often physical resources in compliance with departmental and organizational goals and objectives. Ensures subordinate supervisors and professionals adhere to defined internal controls. Manages systems and procedures to protect departmental assets.

Custom Scope

Coordinates and implements revenue cycle management functions. (Does not include oversight of business office functions.) Monitors effectiveness and recommends improvements to workflows, procedures and technology. Erroneous decisions or failure to adhere to objectives results in additional costs and serious delays in overall schedules.

Responsibilities

% of timeEssential Function (Yes/No)Key Responsibilities (To be completed by Supervisor)

50

Yes

Responsible for achieving broadly stated goals through subordinate team members 

as defined below. 

Ensures the implementation of all revenue cycle policies and establishes, updates, and revises procedures as needed. Researches and incorporates best practices to maintain alignment with current industry standards, regulatory requirements, and emerging trends_._

The Revenue Cycle Manager serves as the principal administrative representative of the CPG Business Office to Zuckerberg San Francisco General Hospital, campus administration, and demonstrates leadership in various committees, and task force services. The incumbent ensures communication development and implementation of mutual goals and objectives, and problem resolution. 

The Manager is required to maintain a strong and functional knowledge of physician billing and reimbursement as well as pertinent local, state, and national issues related to the healthcare industry in the area of academic medicine. Develop, implement, and monitor quality control standards to ensure proper billing, coding and compliance including Medicare and Medi Cal compliance.  This involves working with Client Managers to develop a working plan to meet the billing requirements and back Managers within the department to implement processes.

Proactively, research and address issues/problems constructively, follow through to ensure timely resolutions that in turn improve efficiency, compliance and maximize revenue.  Compliance must be maintained to fulfill UCSF requirements and also in accordance with the Department of Public Health under our Affiliation Agreement with SFGH. Contingencies such as UC’s annual cash security review must be fulfilled just the same with SFGH’s Service Excellence training to maintain our competitiveness as a healthcare facility.  It is the Revenue Cycle Manager’s role to ensure that all staff meet these requirements to support the revenue cycle.

Manage billing and collection operations related to the revenue cycle, including hiring orientation, training required by both UC and San Francisco 

General Hospital, development, coaching, corrective actions, and ongoing monitoring of all staff work-related activities.

Maintain and enhance billing policies and procedures for each function in the Revenue Cycle process to ensure staff adherence to policies.

Ensure consistent quality of the billing service by work redistribution based on skill level and competency to meet the department's productivity

standards.

(Does not include oversight of business office functions.)

15

Yes

Applies proven human resource management skills in staff selection, development, and evaluation. Fosters a strong culture of teamwork and quality customer service to all constituencies to ensure the quality of daily revenue cycle operations, effective interdepartmental collaborations, and the timely achievement of objectives.

Responsible for achieving broadly stated goals through subordinate team members as defined below

Provide mentoring, coaching and performance reviews for both direct reports and indirect reports. Enforce bi-annual performance reviews adopted are perform

Assure that staff meets requirements imposed by UCSF standards and the Department of Public Health (TB/Flu testing, Compliance, Sexual Harassment etc. training,

Works directly with the Director to coordinate training resources and ensure staff are prepared and equipped to adapt to evolving healthcare regulations, industry updates, and operational changes.

Promote employee safety and provide ergonomic resources for staff personnel

Maintain annually department's Emergency Action Plan and Mission Continuity Plan in compliance with UCSF's operational standards.

10

Yes

Establishes processes, metrics and monitoring systems to maximize reimbursement and cash collections. Provides recommendations and corrective action as appropriate.

Delegates projects, directs and monitors work efforts, identifies resource needs, performs quality reviews, and proactively addresses or escalates functional, quality, and timeline related issues to ensure successful project completion and operational effectiveness.

Manages and drives continuous improvement initiatives across all areas of the revenue cycle, identifying opportunities to enhance operational efficiency, optimize financial performance, strengthen compliance, and improve service delivery_._

Ensure consistent quality of the billing service by work redistribution based on skill level and competency to meet the department's productivity

standards.

Monitors CPG and Department Workqueues to ensure timely processing of accounts.

10

Yes

Collaborates with leadership from business units across the medical center (decision support, reimbursement, billing, medical records, clinical units, etc.), to propose new or revised standardization of criteria and measurements, improve workflows, coordinate activities, and resolve issues. Partners with information technology on enhancements and new systems for efficient billing, AR and patient accounting processes.

The Revenue Cycle Manager will maintain regular and effective communication with all existing and prospective clients of the CPG Business Office.  Working with the Chiefs of Service and Department Managers regarding effective and efficient service operation as well as adherence to all regulatory requirements associated with the reimbursement processes.

Works directly with the Director to coordinate training resources and ensure Departments are prepared to adapt to evolving healthcare regulations and industry updates.

5

Yes

Conducts assessments and coordinates the development of training program (job tools, aides and learning delivery methods). Ensures subordinate staff provides departments with ongoing education and training on revenue cycle management policies and procedures.

Provides training resources and development opportunities to support staff in performing their job duties effectively and advancing their careers. Utilizes feedback from sources such as Gallup Employee Engagement Surveys, staff input, performance evaluations, and operational assessments to identify training needs and foster professional growth.

Supports client departments by allocating appropriate resources and providing guidance to help them maximize the use of available reporting tools for financial analysis, operational decision-making, and performance monitoring.

5

Yes

Serves as the liaison between the IT design / build / testing team, the deployment team, as well as revenue cycle and financial business owners.

Collaborate with CPG IT during changes occurring to the EPIC Billing System.

Participate actively in revenue cycle workflows impacting daily operations.

Request system updates as applicable, for charging edits, claim edits and submissions, and denial trends,

5

Yes

Responsible for achieving broadly stated goals through subordinate team members 

as defined below. 

Ensures timely billing and follow up on patient accounts, implementing sound processes, metrics and monitoring systems

Oversees billing management staff to ensure the accurate and timely submission of claims and collection of payments in accordance with all third party payer contracts, including Medicare, Medi Cal, Managed Care, Commercial Insurance, and patient responsible balances.

Oversee the review, resolution, and resubmission of unprocessed, aged, and denied claims to maximize reimbursement and optimize revenue cycle performance utilizing the Epic billing system

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Qualifications

Knowledge, Skills and AbilitiesReq / Pref

Strong knowledge of healthcare revenue cycle operations, concepts, and policies and their impact throughout the organization, with an in-depth understanding of related functions and issues, including coding, registration, billing, reimbursements, aging accounts, contractual adjustments, and charge capture

Req

Strong project management skills with the ability to organize, manage multiple priorities, meet deadlines, and delegate assignments efficiently

Req

Demonstrated leadership and managerial skills, with the ability to create and maintain a goal-oriented climate of teamwork and cooperation across departments for effective problem solving, conflict resolution, support for organizational values, and consistent achievement of targets and objectives Strong critical-thinking, project-management, and problem-solving skills, with the ability to troubleshoot, analyze, and interpret complex data and systems, to quickly identify problems and implement solutions

Req

Ability to work effectively with leadership on establishing operational goals and providing for technological upgrades, tools and systems to maximize revenues

Req

Strong written, verbal, and interpersonal communications skills to prepare and present reports and convey complex information and instructions in a clear, concise, and specific manner

Req

Ability to cultivate a strong commitment to quality, teamwork, collaborative problem-solving, and achievement of objectives

Req

Strong knowledge of metrics, analytics, and data synthesis in healthcare revenue cycle management and their use to identify trends, produce reliable forecasts and projections, and create reports, dashboards, and presentations

Req

Strong knowledge of all relevant of all relevant information technology, including systems, tools, applications, processes, and methodologies

Req