The SNF Revenue Cycle Manager oversees all billing, coding, A/R, and collections to ensure proper reimbursement for skilled nursing facility services. The ideal candidate will have a deep understanding of PDPM (Patient-Driven Payment Model), Medicaid eligibility and billing, managed care contracts, and long-term care reimbursement models . They will lead the billing, coding, accounts receivable (A/R), and compliance teams to ensure regulatory adherence and financial stability Key Responsibilities: 1. Revenue Cycle Oversight Develop and implement strategic plans to optimize the revenue cycle for multiple SNF locations. Oversee Medicare, Medicaid, Managed Care, and Private Pay billing workflows. Ensure PDPM accuracy in reimbursement calculations and billing. Monitor revenue cycle KPIs (Days in A/R, Denial Rates, Clean Claim Rates, Collections). 2. Billing & Claims Management Ensure timely UB-04 claim submissions for SNF services. Work with billing teams to reduce denials and improve first-pass claim acceptance rates . Implement best practices for Medicaid pending claims and eligibility management . Oversee coordination between MDS assessments and PDPM billing compliance . 3. Accounts Receivable & Collections Develop A/R management strategies to reduce aging over 90+ days. Ensure timely collections from insurance payers and private-pay residents . Oversee denial management and appeals to maximize reimbursements. Implement patient responsibility collection procedures , including Medicaid spend-down processing. 4. Compliance & Regulatory Adherence Ensure compliance with CMS regulations, HIPAA, and state Medicaid guidelines . Monitor Medicare PDPM updates, Medicaid changes, and managed care contract requirements . Lead internal audits to prevent fraud, overpayments, and compliance risks . Serve as the primary liaison with state Medicaid agencies and CMS auditors . 5. Leadership & Team Management Manage and mentor a team of billing specialists, coders, A/R analysts, and compliance staff . Collaborate with MDS coordinators, facility administrators, and finance teams . Implement continuous training programs for billing and compliance teams. 6. Financial Reporting & Analysis Generate monthly revenue cycle performance reports for senior leadership. Analyze payer trends and denial patterns to improve cash flow. Provide budget forecasts and financial projections related to reimbursements. Requirements: Experience: 7+ years in revenue cycle management, with 3+ years in SNF/LTC billing leadership . Expertise: Deep knowledge of PDPM, RUG-IV, and Medicaid case-mix reimbursement models . Strong experience in Medicare, Medicaid, and Managed Care contracts . Proficiency in SNF billing software (PointClickCare, MatrixCare, AHT, or similar). Familiarity with CMS audit processes, ADRs, and compliance programs . Skills: Strong leadership and team management abilities. Excellent analytical and financial acumen . Strong problem-solving and negotiation skills for payer disputes . Effective communication with executive teams and facility administrators . Preferred Certifications: Certified Revenue Cycle Executive (CRCE) HFMA Certified Professional Biller (CPB) AAPC Certified Healthcare Financial Professional (CHFP) – HFMA Certified Compliance Officer (CHC) – HCCA
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