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Director of Revenue Cycle
4 months ago
Job Description:
The company, a well-established, award winning Healthcare System with multiple locations in CT has an opportunity for Director of Revenue Cycle.
Responsibilities:
A system-level position overseeing all back-end cycle functions of the Enterprise, the Director of Revenue Cycle, Back End leaders and processes for Billing, Payer Credentialing, AR/Follow Up, Denials Management, Underpayments, Cash Posting, Credits and Self Pay Collections/Customer Service for the company. The incumbent will be responsible for daily operations of all back-end revenue cycle activities while operating in compliance with federal and state regulations, hospital and medical group related policies. The leader is responsible for implementing revenue cycle initiatives while overseeing operations and financial performance of the team's activities. Provides guidance and support in building one back-end revenue cycle team covering the company.
Collaborates with internal partners such as Middle and Front End revenue cycle leaders and Enterprise stakeholders; including, but not limited to, Managed Care. Information Services, Compliance, Risk Management, Case Management; Patient Relations; and clinical and operations leadership for the Hospital and the Medical Group to advance the organization's mission and strategic plan.
Develops policies and procedures regarding all backend revenue cycle processes. Maintains appropriate internal controls and safeguards over allowances and write-offs; ensures compliance with department policies to guarantee proper review and approval of adjustments.
Ensures compliance with state and federal laws and standards related to privacy and security. Meets all required reporting requirements for state and federal laws such as Medicare 838 Quarterly Credit Reporting.
Oversees all functions of back-end revenue cycle, including vendor management, to ensure accurate billing, follow up, collections, cash posting, insurance/patient refunds and customer service for appropriate maximum reimbursement and optimal consumer experience.
Oversees the preparation and submission of monthly bad debt write-off; ensures all hospital and regulatory guidelines are met. Monitors and evaluates collection agency performance to maximize bad debt recoveries; makes recommendations for changes when needed to improve cash flow.
Oversees the integration of the organization Back End revenue cycle functions with Front End.
Leads and collaborates with relevant function area leaders on all federal, state, financial, and third-party payer audit requests (ex: RAC, MSPQ, Equiclaim, Kepro)
Works closely with organization's managed care leader to resolve revenue cycle teams' escalations and lead system-level JOC meetings with managed care stakeholders. Identifies denial patterns and escalates with third party representatives or managed care contract administrators; contributes to the reduction of denials and lost revenues.
Collaborates with Executive Director and senior leadership on system-level strategy as an active member of the implementation/execution team.
Monitors relevant internal and external key performance indicators, meets all documented service level agreements, holds team accountable for results and meeting performance targets.
Provides appropriate training opportunities, mentorship, and support for team members in alignment with the organization's focus on employee engagement and satisfaction.
Qualifications:
Bachelor's degree required. Master's degree in Business Administration, Healthcare Administration or relevant equivalent strongly preferred.
Ten plus years of professional and management experience with at least 5 years of direct supervision in two or more areas of back-end revenue cycle functions (Billing, AR/Follow Up, Denials Management, Underpayment/Variances, Credits, Cash Posting, Self-Pay Collections, Customer Service) required. Previous director level experience required.
Experience managing performance and developing a solid leadership team with more than ten years of experience in leading large revenue cycle hospital teams.
Must have ability to handle multiple priorities and work independently.
Current knowledge of HIPAA, Joint Commission standards, state and federal laws, Consumer Financial Protection Bureau, Legal, Compliance, and Vendor management.
Demonstrates knowledge of computer technology (i.e. Meditech, Epic), Electronic Health/Medical Record systems, and other relevant third-party technology tools.
Knowledge of vendor management and contract negotiation.
Knowledge of healthcare regulatory requirements for Medicare with direct data entry (DDE) and return to provide (RTP) and Medicaid and billing compliance for all government payers and managed care contracts.
Experience with PPT, Word, Excel, custom reporting such as Tableau and other systems.
Collaborative, collegial leader with strong communication skills.
Analytical and results oriented.
Experience managing projects preferred.
A commitment to continuous learning shown through membership in professional organizations like HFMA, MGMA and/or relevant industry standard certifications a plus.
