Revenue Cycle Management
Administrative and clinical functions that contribute to the capture, management, and collection of revenue associated with an encounter created for patient services rendered. Revenue Cycle Management includes the entire life cycle of a patient account from creation until payment on account is received.
To request data or view provider reports, visit kmsf.org/Providers.
Revenue Management & Analytics
- Financial Analysis
- Provides in-depth analysis of comparative data to support decisions impacting the effective operation of assigned clinical practices.
- Evaluates and assists in explanation and interpretation of standard operational, financial, billing, and budget statistical data against budget and benchmark criteria relative to assigned clinical practices for month-end close meetings.
- Identifies opportunities for improvement and streamline workflows to optimize performance.
- Reimbursement Analysis
- Initiates analyses to understand shifts in payor and service mix and provide expert guidance on maximizing collections through data analysis (contracts and reimbursement rates).
- Provides effective analysis of AR, denial, and reimbursement trends, and provides guidance for reversing and resolving any negative trends to provide recommendations and solutions.
- Reviews and monitors reimbursement trends to assess impact of new regulations or codes from a coding, compliance and reimbursement perspective.
- Communication and Collaboration
- Establishes and manages effective on-going communication and education with assigned clinical departments on issues regarding billable services. Communicates the enforcement or revision of revenue cycle policies and procedures, conveying coding guidelines and documentation requirements, including CPT, CMS, and federal, specialty, and payer requirements.
- Interprets, implements, and communicates changes in carrier/payer reimbursement and payer rules to clinical department customers.
- Collaborates with assigned clinical departments on day-to-day front end revenue cycle operations.
Training & Development / Revenue Integrity
- Maintain ongoing training and educational opportunities for employees in coordination with all State and Federal regulations and in areas that would improve employee development and improve capabilities.
- Develop and maintain “super user” capabilities in all KMSF applications and all other related information systems, tools, technologies, and processes; assist other employees as needed to ensure all tools are fully utilized to create an efficient and effective department.
- Support, oversee, and manage the performance and productivity of the team as it relates to Training and Education activities and pre-defined goals/targets, while providing continual feedback and guidance to the team.
- Perform random audits for selected accounts to assure compliance with KMSF policies and procedures.
- Develop training aids and programs that best address the needs of the organization.
- Maintain Master files as it relates to the charge capture process.
For more information on Training & Development, vist KMSF Training.