Director of RCM Payor Team

4 weeks ago

Phoenix, United States American Vision Partners Full time

Company Intro:

At American Vision Partners (AVP), we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nations largest and most comprehensive eye care practices and currently operate more than 120 eye care centers in Arizona, New Mexico, Nevada, California and Texas including 25 ambulatory surgical centers.

At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing best-in-class patient care, pioneering research and technology, and most importantly, rewarding and recognizing our employees

Overview:

As Director of Revenue Cycle Management Payor Teams, you'll be responsible for maintaining and improving revenue cycle processes as well as developing and managing policies and procedures to optimize all facets of revenue cycle operations.

Responsibilities:
  • Ensures compliance with coding and billing regulations and collections policies in order to facilitate attainment of accounts receivable (AR) targets.
  • Lead day-to-day operations and broad scoped work assignments focused on maximizing quality and production processes. Develops new approaches to streamline existing processes, reorganizes work, and improves resource utilization for of coding and insurance billing teams.
  • Monitors and identifies processes to be implemented in order to achieve key revenue cycle metrics including but not limited to cash collections, unbilled A/R, aging over 90 days, and Days in AR. Minimizes contractual and bad debt write offs.
  • Performs ongoing trend analysis on third party payer payment levels and denial rates to ensure that reimbursement is in accordance with allowable amounts stated in agreements and contracts. Works with insurance payors to resolve and recoup underpayment and/or denial issues.
  • Closely monitors denial trends and researches root cause issues while developing solutions to improve overall denial metrics. Collaborates with internal customers to mitigate denial creation.
  • Develops policies and procedures for optimal revenue capture through accurate coding while adhering to all regulatory and compliance standards.
  • Contributes to the development, implementation and evaluation of programs to maximize financial outcomes, patient/physician/provider/employee satisfaction, and reimbursement.
  • Oversees management team to ensure that staff productivity and accuracy audits are being performed, department policies are followed and administered fairly.
  • Resolve complex payer or physician issues when necessary. Act as a primary point of escalation contact for clinical operations for day-to-day operational issues relating to billing, collections and denials.
  • Establishes and maintains proper internal control throughout the organization.
  • Maintains comprehensive knowledge of payer billing requirements and reimbursement policies.
  • Communicates performance data and action plans to leadership.
  • Monitor, assess, and measure the financial impact on the organization of prospective regulatory changes to Federal and State reimbursements.
  • Identify opportunities to maximize reimbursement.
  • Performs other duties as assigned. Maintains strict confidentiality
  • Conducts self in accordance with the companys standard values and policies.
  • Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations.
  • Participates in a variety of educational programs, corporate and professional, to maintain current skill and competency levels.
Qualifications:
  • Minimum five years in a leadership role (manager level or above) within a healthcare revenue cycle department. Two of those years in a Director or equivalent function.
  • Previous management experience with strong leadership skills and an ability to motivate others with a positive attitude.
  • Leadership capability and proven successful experience in managing large revenue cycle teams.
  • Demonstrated experience managing to key performance indicators including experience routinely reporting metrics and managing a team to meet defined metric based goals.
  • High school diploma or GED required.
  • Experience working with NextGen practice management is preferred.
  • Bachelors degree in Health Administration, Business Administration, or related field preferred
  • CPC (Certified Procedural Coder) strongly preferred
  • Expert level knowledge of CMS guidelines, contracted insurance guidelines and coding policies.
  • Advanced PC skills in Excel (advanced formulas, pivot table), PowerPoint, Word and Outlook.
  • Modeling/Reimbursement software or comparable PC based database skills required
  • Well-organized with attention to detail.
  • Ability to read and understand oral and written instructions.
  • Strong analytical and problem solving skills with the ability to define root causes of concerns as they arise.
  • Ability to establish and maintain effective working relationship with team members, clinic staff, payors and patients.


Benefits & Perks:

Your health, happiness and your future matters At AVP, we offer everything medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays plus PTO, Sick Time, opportunity for growth, and much more

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