Director of Revenue Cycle

Director of Revenue Cycle

Position Summary

The Director, Revenue Cycle is accountable for leading, managing, and directing the revenue cycle operations within the Company by providing quality billing and collections services, as well as, accurate, timely and efficient billing, collections, and administrative processes. He/she will be responsible for strategic planning, goal setting, monitoring/measuring work performance, fiscal/budgetary management, operations/workflow management, human resource management, project management, risk management, continuous quality improvement, information management, on-going communication, and customer service within the revenue cycle operations. He/she will also be responsible for insurance eligibility processes, charge processing, claims submission, and processing, payment posting, collections and accounts receivable, denial management, reporting results and analysis, concurrent and retrospective auditing, proper coding, credentialing, insurance contract review and oversight, customer services relative to revenue cycle, training and development related to revenue cycle, analytics of key performance indicators, and all other revenue cycle management activities.

Essential Duties and Responsibilities

·  Responsible for provide leading, managing, coaching and guiding all associates assigned to the department and maintaining positive, effective communication with providers, supervisors, peers, and subordinates.

·  Collaborates with health care providers in assessing, planning, implementing, and evaluating the needs of the patients and the organization. Develops solid, strategic business plans and department SMART goals.

·  Responsible for measuring, monitoring and meeting key performance indicators and departmental goals in accordance with the company’s established policies and procedures and industry best practices.

·  Administers fiscal operations for revenue cycle department, including financial planning, budget development, approving expenditures, meeting or exceeding financial projections, reviewing financial reporting, and explaining variances.

·  Manages revenue cycle related functions of the office/hospital visit from the point of charge entry to full adjudication of the patient’s account. Ensuring timely submission of claims, payment posting, denial management, and statements.

·  Responsible for maximizing the collection of payments and reimbursement from patients, insurance carriers, government agencies, and guarantors.

·  Monitors aged accounts and verifies appropriate collections procedures are being followed.

·  Identifies, analyzes and addresses challenges and/or breakdowns in the revenue cycle process.

·  Plans, implements, and administers programs and services, including personnel administration, training, regulatory compliance, and best practice workflow processes.

·  Develops and implements billing practices by leveraging technology to automate, and standardize processes.

·  Responsible for ensuring proper training is conducted, including: Orientation, skills/competency training, new equipment/process training, continuing education, standard operating procedures, policies and documentation within the electronic practice management system.

·  Rounds frequently to observe, review and analyze revenue cycle operations and workflow activities to ensure best practices are in place and being utilized.

·  Meets regularly with subordinate staff to identify and resolve issues and promote good communication and dissemination of information.

·  Regularly providesEVP,CFO, and revenue cycle staff with revenue cycle status including reports, key performance indicator metrics, and presentations

·  Resolves escalated reimbursement issues with payers, providers, and systems for optimal management of accounts receivable

·  Stays abreast of Medicare/Medicaid and third party payer billing guidelines and communicates these changes to all interest parties.

·  Provides assistance with internal and externally auditing processes

·  Assists in the design of superbills, updating of codes, and charges in the EPM system.

Requirements

·  Bachelor’s degree in Business, Healthcare Administration, Accounting, or related field

·  Minimum of five (5) years of experience in revenue cycle management within a large, multi-disciplinary, ambulatory care operation orFederally Qualified Health Center(PREFERRED)

·  Minimum of three (3) years of experience in successfully leading and managing a high-performance revenue cycle operation, meeting or exceeding industry benchmarks

·  Strong, in-depth knowledge of revenue cycle management principles and practices, including: Medical billing, coding, collections, managed care products, regulatory compliance, payer credentialing, and financial reporting

·  Solid financial management skills, including: Budgeting, forecasting, trending, benchmarking, and financial analysis of the department performance

·  Strong knowledgein the use of Microsoft Office products.

·  Strong knowledge of Athena health, EPM and EHR software.