Director Revenue Cycle Management
2 weeks ago
Bluestone Physician Services’ unique, robust model of care goes beyond primary care services. Our model is tailored to patients living with multiple chronic conditions and disabilities. Bluestone recognizes that patients need a customized approach to care that is preventative, proactive and includes all members of the care team. Medical providers, nurses and social workers collaborate with patients’ other healthcare providers and families.
Our Care Model delivers customized care that is preventive, proactive, and includes all members of the care team, patients and their families. Our patients experience 21% less ER visits, 36% less hospitalization and 41% less hospital re-admissions compared to patients with similar conditions and complexities.
Bluestone has locations in Minnesota, Wisconsin, Florida and uses a mobile clinic approach to provide care to patients within Assisted Living, Memory Care, and Group Home Facilities.
At Bluestone, our employees are our most valuable asset. We know our success is only possible through the hard work and dedication of each of our employees.
Bluestone has been named to the Star Tribune's Top Workplace list for the 11th year in a row Bluestone also achieved Top Workplace USA 2021-2024
Position Overview:The Director Revenue Cycle Management is responsible for the complete cycle starting with provider credentialing, claim review and submission, denial management and ultimately cash collections and accounts receivable management. The Director should actively maintain and expand relationships with health plans to improve financial performance. The Director will also need to work in collaboration with business unit leadership.
The Director is expected to deliver a consistent standard of excellence. Such a standard should be focused on continuous improvement within the Director's area of influence, and deliver the highest degree of quality service.
Responsibilities:
- In-depth knowledge and experience with full claims processing. Includes managing the pre-clearinghouse claim review process.
- Development of meaningful management reports and experience in trend analysis.
- Oversee and manage activities of the provider enrollment process. Ensuring compliance with enrollment policies and procedures.
- Managing denials, resubmissions and tracking of claims. Identifying key drivers/factors that require process change to reduce volume. Socialize issue with group.
- Lead insurance team for new patient registration and appropriate payer assignment. Insurance team also involved in continuous insurance re-verification.
- Electronic/EDI billing and submission of claims and remittance.
- Transaction posting (ACH and checks), adjustment review/analysis and trend reporting.
- Manage the overall collection process with patients (copay and deductibles).
- Analyzing insurance contract terms and conditions regarding claims submission and resubmission timelines.
- Working closely with compliance department and other senior leadership.
- Project management for items identified within Revenue Cycle and as assigned by senior leadership.
Education/Certification/Experience
- Bachelor’s degree in Business, Finance or related field
- 7-10 years of experience managing medical billing department
- Experience with Aprima or similar EHR preferred
- Experience with process improvement or project management
Knowledge/Skills/Abilities
- Knowledge of ICD-10, CPT, HCPCS codes and claim regulatory guidelines
- Working knowledge of Medicare, Medicaid, and third party insurance
- Ability to anticipate future consequences and trends accurately, has broad knowledge and perspective and excellent conceptual and planning skills
- Excellent decision skills based upon a mixture of analysis, wisdom, experience and judgment
- Ability to complete projects on time
- Demonstrated ability to achieve results through managing others
- Strong interpersonal and technical skills
- Skill in identifying and resolving problems
- Strong working knowledge of enrolling and/or credentialing physicians, knowledge of managed care and governmental entities (Medicare/Medicaid)
Bluestone Benefits:
- Health Insurance
- Dental Insurance
- Vision Materials Insurance
- Company paid Life Insurance
- Company paid Short and Long-term Disability
- Health Savings Account (with employer contribution)
- Flexible Spending Account (FSA)
- Retirement plan with 4% matching contributions
- Unlimited PTO and Nine (9) company observed holidays
- Company sponsored cell phone, laptop and computer accessories
- Regular business hours
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