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Director of Revenue Cycle Management

2 months ago

Gainesville, Georgia, United States Northeast Georgia Health System, Inc Full time
About the Role

As a key member of the Northeast Georgia Health System, Inc. team, the Reimbursement Director will play a critical role in ensuring the financial integrity of our organization. This position will be responsible for overseeing all aspects of revenue cycle management, including charge description master functions, reimbursement analysis, and regulatory compliance.

Key Responsibilities
  • Oversight of Charge Description Master functions and reimbursement analysis to ensure accurate and timely billing and reimbursement.
  • Supervision and coordination of Charge-master management functions, including researching coding and billing guidelines, researching insurance contracts, and updating hospital Charge-master.
  • Collaboration with managerial and supervisory staff to ensure regulatory billing with correct coding on accounts.
  • Maintenance of a working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist the health system in cash collection while accurately complying with billing guidelines.
  • Monitoring compliance with corporate, federal, and state guidelines.
  • Overseeing all cost reporting to CMS for funding for GME programs in cooperation with the Finance Department.
  • Analysis of financial data to identify trends and areas for improvement in revenue cycle management.
  • Preparation, monitoring, and filing of Medicare and Medicaid Cost Reports to ensure maximization of reimbursement from third-party payors.
  • Response to surveys affecting Medicare and Medicaid rate revisions, interim payments, and hospital-based physician arrangements.
  • Monitoring changes and proposed changes to Medicare and Medicaid regulations and determining the financial effect of these changes on the organization.
  • Coordination of financial audits conducted by CMS, DCH, and other governmental intermediaries on prior year's cost reports and surveys.
  • Management of Indigent Care Trust Fund processes and reporting.
Requirements
  • Bachelor's Degree in Business Administration, Finance, Accounting, or related field.
  • Minimum 5-7 years of relevant work experience in healthcare financial management, including revenue modeling and CMS cost reporting activities.
  • Strong analytical and problem-solving skills, with ability to research complex coding, reimbursement, and regulatory requirements.
  • Knowledge of clinical settings, such as Laboratory, Radiology, Physical or Occupational Therapy, Respiratory Therapy, Cardiology, or Oncology.
  • Ability to understand and analyze payor contracts/regulations and model net revenue impacts based on reimbursement and coding guidelines.
  • Effective time management skills to permit handling of a large workload.
  • Ability to multi-task and work under aggressive deadlines.
Preferred Qualifications
  • Masters degree or CPA.
  • Operational experience as a Director in a health system.
  • Knowledge of CPT/HCPCS, UB-92 Revenue Coding, modifiers, billing regulations, DRGs, and APCs.