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Director Revenue Cycle
3 months ago
Job Summary: The Director of Revenue Cycle directs and oversees the overall policies, objectives, and initiatives of Diversus Health’s revenue cycle activities to optimize the client’s financial interaction along the care continuum. Reviews, designs, and implements processes surrounding admissions, pricing, billing, third party payer relationships, compliance, collections, and other financial analyses to ensure that clinical revenue cycle is effective and properly utilized. Tracks numerous metrics related to the client engagement cycle including coding error rates, collection rates, and billing turnaround times to develop sound revenue cycle analysis and reporting. Manages relations with payers and providers to generate high reimbursement rates and a low level of denials. Ensure all responsible areas are compliant and responsive to Diversus Health’s goal of continuous improvement of our revenue cycle and customer service functions.
Essential Functions:
Team Management: Lead, mentor, and manage a team responsible for billing, denial management, collections, and revenue cycle operations. Responsible for the development and retention of competent supervisors and staff
Strategic Leadership: Develop and execute revenue cycle strategies aligned with the organization's goals to enhance revenue generation and client experience. Identify opportunities for streamlining revenue cycle processes, implementing best practices, and enhancing efficiency in billing, coding, and reimbursement workflows. Work closely with leadership, clinical, and administrative teams to facilitate accurate documentation, coding, and billing practices while promoting interdisciplinary collaboration.
State-Driven Reimbursement Knowledge: Stay abreast of state reimbursement requirements and potential changes, including potential shifts to models like PPS (Prospective Payment System) or adherence to a CCBHC (Certified Community Behavioral Health Clinic) model. Proactively assess the impact of these changes on revenue cycle operations and develop strategies to ensure readiness and compliance with evolving reimbursement models, working collaboratively with relevant stakeholders to adapt processes accordingly.
Vendor and Payer Relationships: Manage relationships with third-party vendors, payers, and insurers to negotiate contracts, resolve billing issues, and optimize reimbursement rates.
Training, Education, and Compliance Monitoring: Monitor compliance with healthcare regulations, billing guidelines, and organizational policies, ensuring staff members possess current knowledge and understanding to maintain adherence to regulatory standards. Implement necessary adjustments to ensure continuous adherence to industry standards and organizational policies.
Financial Analysis: Analyze revenue cycle metrics, financial reports, and key performance indicators to assess performance, identify trends, and make data-driven decisions.
Technology Utilization: Oversee the implementation and optimization of revenue cycle management systems and technologies to improve operational efficiency and revenue capture.
The environment at Diversus Health is fluid and roles and responsibilities may be altered to accommodate changing business conditions and
Knowledge/Skills/Abilities:
Education: Bachelor’s degree in business or related field, MBA preferred.
Knowledge of Behavioral Healthcare: Understanding of behavioral health services, terminology, and billing/coding requirements specific to the field. knowledge of healthcare regulations, compliance requirements (HIPAA, CMS guidelines), and payer policies.
Revenue Cycle Expertise: At least five years of progressive health care revenue cycle operations with at least three years of previous management/supervision experience. Experience with medical claims processing, collections, and cash flow management. Accounting knowledge desired.
Leadership Skills: Strong leadership and managerial abilities to motivate, develop, and manage a team effectively. Excellent communication and interpersonal skills to collaborate effectively with internal teams, external stakeholders, and vendors.
Technology Proficiency: Proficiency with electronic health record systems, Microsoft Excel, Word, and Power Point.
Strategic Thinking: Ability to develop and execute strategic plans to enhance revenue cycle operations and financial performance. Flexibility to adapt to changes in healthcare regulations, industry trends, and organizational needs.
Embodies a commitment to:
Passion: a commitment to being present in the moment to create excitement and allow individuals to utilize their passion in daily functions. Help individuals connect their daily responsibilities with Diversus Health’s larger mission.
Humility: Level setting with all parties and advocates for all voices within Diversus Health
Corporate Citizenship: continued commitment to behave ethically and contribute to economic development while improving the quality of life of our workforce and their families, as well as of the local community and society at large.
Value in diversity: ability to recognize the value in differing perspectives, culture, etc., and leveraging those diverse components to develop experiences aligned with our internal and external communities.
Innovation: thinking differently than the status quo to explore opportunities that provide a competitive advantage.
FUN: Contribute to, and be part of, an environment where individuals feel joy, comfort and connected to the organization’s larger initiatives, while simultaneously experiencing a sense of cultural acceptance and belonging
Integration: cross functional implementation of theory, principles, and best practices from across the behavioral health industry in order to improve execution of strategies and deliver high quality experiences
Excellence: unwavering commitment to work that reflects the standard our colleagues and persons expect and deserve.
Transparency: communication, steward of resources, and the mistakes one makes (Fail/Fail Fast/Fail Fast Forward), while giving credit where it is due.
Safety: speaks to interconnectedness of all facets (departments and personnel) of the organization
At Diversus Health, we believe in a truly healthy society where mental and behavioral healthcare unite to make lives better. Our goal is to help people lead healthier, more fulfilling lives by improving access to trusted, affordable, and personalized mental healthcare. Every day. It is a lofty goal; we know. But we make it happen with the best team in behavioral health.
Thank you for taking the time to explore a career with us.
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The Environment at Diversus Health is fluid. Roles and responsibilities may be altered to accommodate changing business conditions and objectives. Employees may be asked to perform duties that are outside of the specific work that is listed. This position may require you to work standard hours, as well as flexible hours before and after standard hours, and overtime in excess of 40 hours in a work week.
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