Job Description

APLA Health’s mission is to achieve health care equity and promote well-being for the LGBT and other underserved communities and people living with and affected by HIV. We are a nonprofit, federally qualified health center serving more than 14,000 people annually. We provide 20 different services from 15 locations throughout Los Angeles County, including: medical, dental, and behavioral health care; PrEP counseling and management; health education and HIV prevention; and STD screening and treatment. For people living with HIV, we offer housing support; benefits counseling; home health care; and the Vance North Necessities of Life Program food pantries; among several other critically needed services. Additionally, we are leaders in advocating for policy and legislation that positively impacts the LGBT and HIV communities, provide capacity-building assistance to health departments across the country, and conduct community-based research on issues affecting the communities we serve. For more information, please visit us at aplahealth.org.

We offer great benefits, competitive pay, and great working environment!

We offer:

• Medical Insurance
• Dental Insurance (no cost for employee)
• Vision Insurance (no cost for employee)
• Long Term Disability
• Group Term Life and AD&D Insurance
• Employee Assistance Program
• Flexible Spending Accounts
• 10 Paid Holidays
• 3 Personal Days
• 10 Vacation Days
• 12 Sick Days
• Metro reimbursement or free parking
• Employer Matched 403b Retirement Plan

This is a great opportunity to make a difference!

Revenue Cycle Manager (90005)

This position pays between $65,526 – $83,739. Salary is commensurate with experience.

POSITION SUMMARY: 

Responsible for overseeing the revenue cycle, developing and monitoring billing staff productivity standards, and preparing and reviewing performance reports. Ensures accuracy and compliance in billing, collections, denials, and financial screening areas (sliding fee discount, patient refunds, patient collections).

ESSENTIAL DUTIES AND RESPONSIBILITIES: 

• Establishes revenue cycle benchmarks and standards of practice; develops reports on benchmarks and trends and reviews on a monthly basis with CFO.
• Responsible for oversight of posting of charges, adjustments and payments to patient accounts, assuring accuracy and timeliness; collaborates with Controller to reconcile monthly payment posting into eClinicalWorks to bank records for posting in the accounting system.
• Prepares and submits quarterly Medicare credit balance reports.
• Audits no less than 100 claims per location per month to determine correctness of insurance selection by front office staff.
• Audits diagnosis and procedure coding within eClinicalWorks on a regular basis; establishes a monthly audit protocol to ensure appropriate coding for optimal billing.
• Reviews denials and returned claims, and determines procedural errors; corrects and implements workflows to eliminate/minimize errors.
• Directly supervises Revenue Cycle Supervisor, manages all staff workflows and ensures denials are worked and collected in a timely fashion.
• Educates front office and clinical staff and providers on payer specific policies and general coding guidelines.
• Works with CFO to set up new Medi-Cal and Medicare accounts in eClinicalWorks for new clinics are required.
• Participate in annual audits as required with questions related to billing and sliding fee.
• Stays current with legal and regulatory changes, and local and national trends, in coding.
• Maintains current knowledge of Medicare, Medi-Cal, and other third-party payer rules and regulations with respect to billing and other matters, and communicates information to medical leadership as appropriate.
• Maintains current working knowledge of eClinicalWorks (eCW) billing module.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.

REQUIREMENTS:

Training and Experience:

• High school diploma or GED required; BA degree preferred.
• Certification as a Certified Professional Coder or a Certified Coding Specialist preferred.
• Must have at least three years of coding experience. Medical coding required; dental and behavioral health a plus.
• Must have at least five years of direct billing experience using the practice management system of an electronic health record.
• Must have at least three years of experience directly supervising staff.
• Federally Qualified Health Center billing experience required.
• Experience with eClinicalWorks or a similar electronic health record preferred (will train on eCW).

Knowledge of:

CPT, HCPCS and ICD-10 coding protocols, Medi-Cal, Medicare, managed care and private insurance billing, My Health LA and ADAP/PrEP-AP, and medical coding. Knowledge of FQHC billing protocols including split billing for PPS rates. Must be proficient in the use of Microsoft Office programs.

Ability to:

Communicate effectively with providers, other staff, and outside vendors. Must be well-organized and detail-oriented.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS:

This is primarily an office position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer terminal and on paper.

SPECIAL REQUIREMENTS:

Must possess a valid California driver’s license; proof of auto liability insurance; and have the use of a personal vehicle for work related purposes.

Equal Opportunity Employer: minority/female/disability/veteran.

How to Apply

Job Categories: Equal Opportunities. Job Types: Full-Time. Salaries: 60,000 - 80,000.

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