Revenue Cycle Director
1 week ago
The Revenue Cycle Director is responsible for the successful oversight, management, administration, and supervision of all functions related to insurance and self-pay billing and collections performed in the central billing office, as well as authorizations and referrals. The Revenue Cycle Director will assist with the development and implementation of policies, procedures, objectives, and initiatives of IMS to ensure financial stability and support the delivery of high-quality care. The Revenue Cycle Director will create and review monthly reports, analyze outcomes, identify trends, and ensure timely and proactive communication to the Vice President, Revenue Cycle and Leadership teams.The Revenue Cycle Director originates, implements, and leads billing office objectives that will provide IMS an employee-oriented, high-performance culture that emphasizes empowerment, quality, productivity and standards, goal attainment, and the recruitment and ongoing development of a superior workforce. Instill the IMS mission, vision and values in the work performed.
ESSENTIAL FUNCTIONS
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job's purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Development of the Billing office Department
- Works collaboratively with the Vice President, Revenue Cycle on Key Performance Indicators (KPI's) and effectiveness of the revenue cycle team.
- Manage all billing functions ensuring all claims are billed accurately, in complete compliance with regulatory and company requirements, and within timely filing guidelines. Ensures accurate reimbursement is being received for services rendered.
- Manage the daily activities of the business office including front end coding, billing, claim review, denial management, authorizations, referrals, collections, and payments.
- Must have experience reading and understanding payer remittance advices.Includes the ability to differentiate between allowed charges, contractual adjustments, line-item denials / reasons, patient responsibility (co-pay, co-insurance, and deductibles), bundled payments, etc.
- Active knowledge of CMS guidelines, contracted insurance guidelines and coding policies.
- Must have thorough knowledge of ICD, CPT, and HCPCS coding principles.
- Assists with the development, implementation, and monitoring of quality assurance reviews for staff and providers.
- Oversees and manages the work of billing office staff and encourages the ongoing development of the billing office staff.
- Respond to provider/staff requests accurately and in a timely fashion.
- Address patient concerns and escalation, promptly and professionally.
- Foster a culture of continuous improvement, accountability, and excellence.
- Participates in management staff meetings and attends other meetings and seminar.
- /Works daily with the Vice President, Revenue Cycle to define daily revenue expectations, discuss opportunities and resolve challenges
- Maintain a strong working knowledge of the systems used and be prepared to provide support to staff and management when requested.
- Serve as a resource for the revenue cycle team and practice leadership by assisting them with the analysis of current performance through data.Support and help with interpreting the data to identify process improvements that support revenue cycle services.
- Remains current on the specific data requirements as dictated by various government and private insurance carriers and ensures the system(s) are appropriately updated.
- Analyze, review, and develop reports necessary for the billing office to ensure IMS goals and guidelines are achieved.
- Be hands-on in supporting the team with daily tasks
- Coach staff on call handling improvement techniques.
- Encourage and assists with the ongoing development and education of staff.
- Coach staff on call handling improvement techniques.
- Lead performance management, mentoring, and staff development; ensure training and reference materials are up to date and provide training to keep staff updated on trends.
- Defines billing office training programs by adequately supplying, identifying, and developing the resources required to achieve the IMS goals and expectations of billing operations.
- Responsible for managing the on-going user training for new hires and existing staff in the business office and clinics to ensure the systems are utilized to their fullest capabilities.
- Provides continuing education regarding insurance carrier changes and updates.
- Partner with Vice President, Revenue Cycle on policies and procedures throughout the billing operation to standardize operations, communicate expectations, and establish agreed upon outcomes.
- Partners with management to communicate policies, procedures, and programs that impact the practices within IMS.
- Supervise the performance and provide evaluation of the Revenue Cycle operations team and business office.
- Promotes the IMS accepted employee relations practices necessary to establish a positive employer-employee relationship and promote a high level of employee morale and motivation.
- Works with Human Resources to conduct investigations with employee complaints or concerns are brought forth.
- Monitors the implementation of a performance improvement process with non-performing employees.
- Manages, trains, orients and evaluates performance of assigned personnel.Recommends merit increases, promotions, and disciplinary actions.
- Fosters relationships internally and externally, to include but not limited to, practices, IMS departments, vendors, and insurance carriers.
- Leads the development of departmental goals and metrics for billing office to include but not limited to days in AR, Collection ratio, accepted timeframe of charge entry and payment posting.
- Trend and analyze denials and front end failed claims for training and development of clinic staff and revenue cycle team.
- Manages employee communication and feedback through such avenues as office/ departmental meetings, memos, and one-on-one meetings.
- Monitors revenue cycle worklists and buckets with the EHR and delegates accordingly.
- Mentor and monitor the volume of employees' work in all departments of the central billing office.
- Maintains an understanding of front office process and procedures for improvement initiatives as it applies to revenue cycle workflows.
- Ensures completion of annual audits of providers and staff as needed to ensure accurate and timely coding and billing activities.
- Utilizing MS-Excel for analyzing data using basic formulas, pivot tables, and charts.
- Creates reports and accurately presents them.
- Recognizes possible solutions to problems and is able to explain issues and propose solutions.
- Maintains customer confidence and protects operations by keeping information confidential.
- Contributes to team effort by accomplishing related results as needed.
- Manages multiple projects and deadlines.
- Travel may be required depending on business needs.
- Hours may vary and be outside of normal office hours depending on business needs.
- Performs all other duties as assigned.
- Bachelor's degree in Healthcare Management/Administration, Finance, Business Administration or a related field is preferred.
- Certified Professional Coder (CPC) certification preferred.
- 5 years' experience required, specifically overall revenue cycle management of a large (50-100+ providers) medical group practice with knowledge of the physician billing and insurance claim follow-up and denial management process preferred.
- 3-5 years minimum of direct management experience of a team is required.
- Financial management, including the ability to analyze data for operations, budgeting, auditing, and forecasting.
- Basic accounting knowledge including A/R analysis, staffing and financial reporting skill.
- Excellent interpersonal skills, with a demonstrated ability to work with a wide variety of people, both within the system and outside.
- Ability to plan, organize and effectively lead multi-disciplinary teams and projects and develop meaningful results within established timeframe.
- Working knowledge of electronic billing systems and strong working knowledge of governmental billing requirements and resources.
- Demonstrated experience in implementing electronic healthcare systems.
- Exceptional verbal and written communication skills in relaying technical information to non-technical advisers.
- Demonstrated ability to serve as a successful participant on a management team that provides company leadership and direction.
- Demonstrated ability to interact effectively with peers and subordinates.
- Excellent computer skills in a Microsoft Windows environment.
- Demonstrates attitude of accessibility and availability.
- General knowledge of various employment laws and practices.
- Evidence of the practice of a high level of confidentiality.
- Excellent organizational and record keeping skills.
- The ability to work in a constant state of alertness and in a safe manner.
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