Director of Revenue Cycle

Job Summary:

The Director of Revenue Cycle is responsible for the direction and leadership of operational, financial, personnel activities for Revenue Cycle, including provider enrollment, claims, payments, credit balance, insurance reimbursement, patient access, coding, and self-pay management. This includes establishing and continuously monitoring the goals and objectives while maintaining alignment with the strategic goals and objectives. While the range of duties and responsibilities is broad and varied, the position’s major responsibility is directing the day-to-day operations, budgeting, financial management, and human resource management. The Director works closely with a variety of stakeholders, coordinating the activities of the Revenue Cycle across the enterprise. The Director of Revenue Cycle serves as the operational leader for the Revenue Cycle and is responsible to the Chief Financial Officer.

Job Relationships:

1. Directly responsible for patient access, authorizations, referrals, coding, billing, utilization management, and collections.
2. Works closely with executive team, directors and managers, vendors, and other key stakeholders.

Occupational Hazards:

Works in the general hospital setting and possible exposure to blood, body fluids, or tissues as well as patients in varying stages of infectious states.

Samples of Duties:

• Oversee and manage entire revenue cycle including patient access, billing, coding, collections, and denial management
• Manage relationships with external vendors
• Communicate professionally with various payers
• Manage, develop, and mentor all revenue department staff, including billers, coders, and patient access supervisor
• Oversee the admission process and manage the admissions team
• Provide up to date education for clinical, billing, and coding staff on coding trends
• Develops, evaluates, implements, and revises policies and procedures related to billing, coding, reimbursement activities and improvement strategies
• Reconcile all receivables and revenue reports and work closely with the finance department in the development of the monthly financial statements
• Manage and update the charge master based on the current CMS fee schedule and negotiated contracts
• Conduct monthly analysis of Medicare/Medicaid/Third Party Payers
• Oversees the processing of credentialing and provider enrollment applications, initial, and re-enrollment status with all Medicaid, Medicare, and Commercial Payors
• Responsible for the generation and management of revenue, admissions, and credentialing metric reports
• Review and resolve issues related to claim generation and rejected/denied billings
• Commit to highest level of business and patient confidentiality possible adhering to all HIPAA and security guidelines when accessing and sharing patient information

Knowledge, Skills and Abilities:

Knowledge of:

• The Mission, Vision, and Values of Northern Inyo Healthcare District;
• NIHD policies and procedures, including Compliance Program, Code of Conduct, and Confidentiality standards;
• NIHD safety policies and procedures, including the Rainbow Chart, Employee Health, and Infection Prevention standards;

Skills/Abilities to:

• Communicate effectively both verbally and in writing with NIHD staff and the public;
• Establish and maintain professional working relationships with NIHD staff at all levels as well as the public;
• Develop and maintain a high degree of maturity, integrity, and good judgement.

Minimum Qualifications:

Experience:

• At least three (3) years of related work experience
• Knowledge of third-party payer requirements including federal, state, and private health care plans and authorization processes
• Proven experience in healthcare billing, including Medicaid/Medical Assistance
• Knowledge of basic insurance policies, procedures, and reimbursement practices with Medicare coding
• Experience supervising staff
• Prior experience with process development and execution
• Excellent communication and interpersonal skills
• Certified coder, coding auditor, or coding education experience
• Billing experience

Education:

Certification:

• Medical Billing or certified Coder

Preferred:

Experience:

• 5 years of healthcare revenue cycle directorship
• Experience with Cerner Millennium/Works

Education:

• Bachelor degree

Certification:

• Coding or Medical billing certificates

This position is management