Revenue Cycle Consultant- Des Moines, IA

The Iowa Primary Care Association’s (Iowa PCA’s) vision is health equity for all.  Our mission is enhancing community health centers’ capacity to care. All employees of the Iowa PCA are expected to represent the company vision and mission. 
The Revenue Cycle Consultant will support member centers through developing and providing training and technical assistance (T/TA) for revenue cycle management activities including pre-appointment (collection of insurance information, eligibility, etc.), during appointment (coding, charge capture) and post-appointment (billing, claims submission, A/R, collections, reimbursement, denials). This position will be an integral team member in planning, implementing, and training on critical revenue cycle optimization and transformation activities to ensure success in value-based purchasing arrangements, such as the Medicare Shared Savings Program (MSSP) and a Medicaid Alternative Payment Methodology (APM.) The Revenue Cycle Consultant will deliver T/TA to centers for their RCM Premium Services agreements. This position will also represent Iowa PCA and Iowa CHCs to managed care Medicaid plans.  
The following duties are normal for this position.  These are not to be construed as exclusive or all inclusive.  Other duties may be required and assigned. 
  • Deliver T/TA to member health centers as part of their RCM Premium Services agreements. This position does not do direct billing, but rather helps center billers optimize operations and implement new regulations or establish best practices.  
  • Organize and lead revenue cycle T/TA to health centers, including development and presentation of training materials for best practices, compliance, etc.  
  • Independently lead Revenue Cycle Management & Payor Relations Workgroup.  Plan and facilitate monthly webinars and semi-annual face to face meetings on prioritized topics. 
  • Works in a consultative role training health center staff, including providers and clinical staff, on payer specific (Medicaid, Medicare, Commercial insurance) policies, coding guidelines, coverage requirements (including prior authorization, referrals, etc.) and best practices.  Must emphasize building those relationships. This includes onsite T/TA and well as virtual/remote support.  
  • Perform statewide revenue cycle key performance indicator (KPI) benchmarking including gathering, summarizing, analyzing and reporting data.  
  • Independently make decisions on how to gather, summarize and track health center Medicaid Managed Care and billing/claims issues to analyze payment trends for escalation to Iowa PCA leadership who will escalate to Iowa Medicaid and MCOs. Track and analyze center accounts receivable and reimbursement data as data sets allow.  
  • Research escalated health center reported billing/claims issues to determine root cause and pervasiveness/impact across the network.  Work with payers to develop and deploy a fix and ensure adequate training and communication and drive to resolution. 
  • Serve as subject matter expert on Federally Qualified Health Center (FQHC) reimbursement for both Iowa Medicaid and Medicare, including the PPS, wrap, cost reporting and cost settlement processes, including implementation of the APM. 
  • Serve as billing/coding subject matter expert for pay for coordination and other payor population health management programs to ensure program compliance for reimbursement.  Examples of these programs include MIPS, Medicaid Chronic Condition Health Home and Integrated Health Home programs and the Medicare Chronic Condition Management and Annual Wellness Visit requirements, telehealth, and dental and behavioral health integration opportunities. 
  • Work with health center Finance leadership to develop and implement revenue cycle performance improvement projects with member centers to achieve health center and network goals as network and center time allows. This may require working with health center finance teams.  
  • Work with the Integrated Health and Data & Technology Teams on innovative performance improvement projects to understand and implement opportunities for enhanced coding for accurate risk capture and reimbursement maximization. 
  • Collaborate with Iowa PCA Help Desk staff and vendors on tickets related to the hosted Practice Management system that requires expert knowledge of revenue cycle or payor processes.  
  • Manage and develop a high degree of expertise in revenue cycle operations, technical processes, and financial reports (UDS, VIS, etc.), as well as understanding the measures as new programs are rolled out. 
  • Evaluate emerging RCM HIT tools, make recommendations, and if approved, support health centers with implementation of tools and solutions to improve revenue cycle efficiency and effectiveness.  
  • Serve as escalation point for health center RCM teams on RCM operational issues, providing T/TA or referrals as appropriate.  

Expected Values and Behaviors:  
The person in this position will be expected to model our workplace values which are:  

  • Collaborative – We are one team. Celebrate success together. Learn from failure together.  Willing to embrace change and responsive to each other. We can and should depend on each other. Share your work and ask questions. Offer to help, offer to learn, and offer solutions to problems. 
  • Accountable – We work for health centers and we work with each other.  Tell the truth, keep your word, listen, and make it better. Expect excellence from yourself and others. 
  • Respectful – Approach every interaction with thoughts of equity, inclusion, and humility. We are one organization, and we are many people. We understand our differences and are better for it. Welcome feedback of all kinds. We are all learning something. 
  • Deliberate – Always understand the problem before trying to solve it. Nothing should be done without a purpose. Unite around common goals, visions, and strategies. 
  • Proactive – We seek opportunities to learn and prepare for future challenges. Everyone is responsible, expected and empowered to prepare us for the future. Train and plan for what comes next and who comes after us. 
  • Transformative – We empower systems change with a lens of excellent healthcare, health equity and compassion. Or health centers lead the way; we will clear the way. Adapt to changing circumstances and improve through adversity. 

Telecommuting and Travel:  
This position is required to be on-site at least two days per work week. 
Some travel may be required to community health centers via vehicle or conferences via air travel. 

This position does not have supervisory responsibilities. 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Education and/or Experience: 

  • Bachelor's in business administration, healthcare administration / management or a related healthcare field, along with 5 to 7 years of revenue cycle management experience.  
  • Current CPC, CFPC, CRC or other billing/coding certification preferred.  
  • Thorough working knowledge of CPT and ICD-10 coding protocols and procedures. 
  • Proven experience with performance improvement methodologies (LEAN, Six Sigma, PDSA), etc. and responsibility for application within a clinical setting required. 
  • Ability to build rapport with diverse audiences. 
  • Ability to work independently in a consultative capacity while leveraging/influencing others to achieve goals.  Results-oriented. 
  • Ability to manage, work and deliver results on multiple projects at the same time. 
  • Ability to independently create and present training to others.  
  • Thrives off new challenges, variety and flexibility to work independently and empowered to make decisions. 
  • Excellent written and oral communication skills with the ability to provide clear, concise directives. 
  • Experience with setup, management, and maintenance of at least one Practice Management software preferred.  
  • Well-versed with all federal, state and HIPAA privacy regulations. 
  • Knowledge of medical necessity rules and procedures impacting claim submission, denials and insurance reimbursement. 
  • Knowledge of FQHC regulatory requirements, health care delivery standards, policies and procedures is strongly preferred.  
  • Ability to navigate, develop, and maintain relationships with state Medicaid, plan leadership, and other stakeholders in a manner that maintains professionalism and represents the interests of Iowa PCA and Iowa CHCs.  

To Apply: Click Submit Your Resume and name the position interested as the same position name on this opening.

Additional Info

  • Specialty: Iowa Primary Care Association
  • Position Type: Full Time
  • Location: Des Moines

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