Revenue Cycle Lead

LAFAYETTE HOSPITAL + CLINICS • Darlington, WI • 4d ago

JOB REQUIREMENTS: Revenue Cycle Oversight & Denial Management Review and analyze claim denials to identify trends by payer, plan @type, service line, authorization, or documentation requirement. Develop and communicate actionable recommendations to reduce repeat denials and improve reimbursement outcomes. Monitor insurer policy changes and ensure internal workflows, education, and processes adapt accordingly. Track high-risk and high-effort claims to ensure appropriate escalation, appeals, and resolution. Serve as a point of accountability for complex claims requiring advanced analysis or cross-department coordination. Billing, Authorization & Payer Collaboration Collaborate with registration, coding, billing, and clinical staff to ensure compliance with payer-specific requirements. Support prior authorization processes by identifying gaps, trends, or payer-driven challenges. Coordinate with off-site billing partners as needed to resolve complex billing or reimbursement issues. Review payer contract terms and support payer contract negotiation efforts in coordination with leadership. Support provider credentialing and licensing activities as needed to ensure timely reimbursement. Reporting & Financial Support Analyze reimbursement, denial, and follow-up data to support cash flow and financial performance. Prepare reports and summaries for finance leadership related to revenue cycle trends and outcomes. Assist with special projects, audits, and reporting requests as assigned. Education & Continuous Improvement Provide feedback, education, and guidance to staff related to documentation standards, authorization rules, and payer expectations. Participate in continuous improvement initiatives focused on revenue integrity and process efficiency. Serve as a subject matter expert and resource for revenue cycle questions across departments. Patient Financial Advocacy Serve as a liaison between patients and the finance department to support consistent, clear communication regarding financial matters. Assist finance staff and patients, as requested, in understanding insurance coverage, benefits, and financial responsibility. Support identification of patients eligible for Medicaid, charity care, or other financial assistance programs. Coordinate communication to ensure patient questions or concerns are addressed promptly and accurately. Other Responsibilities: Serve as a problem-solving resource for revenue cycle and finance-related inquiries. Assist with special projects and reporting requests as assigned. Represent the Finance Department in internal committees or external meetings as assigned. ** OTHER EXPERIENCE AND QUALIFICATIONS: Minimum of 35 years of experience in hospital or clinic billing, revenue cycle management, patient accounting, or related healthcare finance roles. Strong working knowledge of insurance reimbursement, payer policies, prior authorization requirements, and claim denial processes. Experience analyzing denial trends and payer behavior. Proficiency in Microsoft Excel and healthcare billing or patient accounting systems. Knowledge of hospital information systems and clearinghouses preferred. Excellent analytical, organizational, and problem-solving skills. Strong verbal and written communication skills, with the ability to work collaboratively across departments. Ability to manage complex issues, multiple priorities, and sustained follow-up efforts. Ability to sit for extended periods; occasional walking. Ability to frequently lift, carry, push or pull up to 25 pounds, and occasionally lift, carry, push or pull over 25 pounds. Must handle deadline pressures, shifting priorities, and problem resolution. Ability to communicate effectively and work independently or as part of a team. ** APPLICATION INSTRUCTIONS: Apply Online: https://www.lafayettecountywi.org/hr/job-opening/lhc-full-time-revenue-cycle-lead

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