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Director, Revenue Cycle
2 months ago
The Director of Revenue Cycle reports to the Chief Financial Officer and is responsible for directing Patient Financial Services (Revenue Cycle), to include Billing, Collections, Customer services, Cash posting, and Denial Management. They are responsible to coordinate daily activities related to the planning, implementing and maintaining of all functions pertinent to the Revenue Cycle department. This senior leader is responsible for continued improvement of assigned staff through education, training and positive reinforcement of appropriate working practices. Must be able to meet performance goals to include cash, A/R days, production by area, denial reduction, monthly close and daily cash reconciliation. The successful leader will monitor performance through key performance indicators, establish best practices, policies and monitoring to assure quality and compliance, and report regularly to executive leadership regarding performance of their assigned area of responsibility.
Requirements:Directly manages day-to-day activities of coding, patient accounting and billing staff:
Oversees submission of electronic and paper claims, posting of payments and adjustments to accounts.
Ensures daily electronic/paper billing submission to appropriate payer and oversees the resolution of billing and insurance issues, collections follow up and financial reporting.
Optimizes reimbursement and maintains cash flow at acceptable level
Regularly evaluates departments' performance both qualitatively and quantitatively as it relates to reimbursement.
Oversees the development and maintenance of fee schedules, chargemaster and procedure / diagnosis code master file.
Ensures compliance with price transparency posting requirements.
Oversees going analysis of contract compliance and financial performance for third-party payers. Uses data to conduct preliminary contract negotiations with the VP of Finance and the 3rd party payers.
Proactively provides KPI reports to the CFO executive leadership, at the beginning of each month, that identifies root causes of collection rates or cash flow performance.
Maintains days in A/R at or below industry standards.
Responsible for all aspects of individual supervision for all staff assigned including interviewing, hiring, orientation, scheduling, goal setting, progressive discipline/termination and annual performance reviews in a timely manner.
Directly manages policies, processes and reporting of patient accounting
Designs, implements, and evaluates improvements aimed at increased efficiency; supports the assessment of current revenue cycle function.
Establishes and maintains standardized policies and processes based on industry best practices, incorporating and delivering high quality results.
Establishes internal controls to ensure timely and accurate billing to third party carriers.
Establishes policy and procedure for appropriate follow-up while monitoring staff productivity, quantify the quality and timeliness of staff efforts.
Keeps abreast of billing regulatory changes and informs staff of new developments. Conducts in-service education sessions where applicable.
Identifies and documents all system related issues. Monitors implementation/updating electronic billing systems.
Promotes and provides quality customer service and proactively identifies and resolves customer issues.
Must have demonstrated ability to interact positively with Administration, Directors, Managers, Supervisors, peers, co-workers, subordinates, patients and visitors.
Skills/Qualifications:
Ensures compliance with state, federal, and regulatory agency requirements for facilities and staff.
Collaborate with Chief Financial Officer to support operational leaders with business acumen training for the organization.
Demonstrated experience with Customer services, Cash posting, Denial Management and Budget preparation.
Demonstrated experience in daily activities related to the planning, implementing and maintaining of all functions pertinent to the Revenue Cycle.
Demonstrated experience with the continued improvement in staff through education, training and positive reinforcement of appropriate working practices.
Must be able to meet performance goals to include cash, A/R days, production by area and denial reduction.
Required and Preferred Education, Experience and Certifications:
Minimum of five (5) years of increasingly responsible management experience in a healthcare setting required, with previous experience as a senior leader in a multi-specialty clinician and facility revenue cycle environment strongly preferred.
Bachelor’s degree in accounting, finance, healthcare administration/management, or other relevant area of study required. Master's degree preferred
Certified Medical Group Practice Executive preferred but not required.
Certified Professional Coder a plus, but not required.
Work Environment:
While performing the duties of this position, the employee is exposed to inside environmental conditions, protected from weather conditions but not necessarily from temperature changes. The employee may be exposed to dust, pollens, pollutants, fumes and communicable diseases as related to a health care environment. The noise level in the work environment is usually low to moderate.
Physical Demands:
While performing the responsibilities of this position, the employee is regularly required to talk, and have hearing sufficient to understand conversations, both in person and on the telephone. The employee is often required to sit for potentially long periods of time throughout the workday. Manual dexterity of hands and fingers, to handle or feel and to manipulate keys on a keyboard. The employee is occasionally required to stand; walk, climb or balance; stoop, kneel, or crouch; lift and/or move up to 25 pounds and use hands to finger, handle, or feel objects, tools, or controls, and reach with hands and arm. Vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus sufficient to operate computer systems. Reasonable accommodation can be made to enable people with disabilities to perform essential functions of this position in relation to the physical demands detailed above.
