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Revenue Cycle Director

1 month ago

New London, Connecticut, United States OperationsInc Full time
Revenue Cycle Manager

OperationsInc is seeking an experienced Revenue Cycle Manager to join their team. This role plays a critical part in managing the financial health of the organization by overseeing all aspects of client accounts receivable, billing, and collections processes.

The ideal candidate will bring strong leadership abilities, excellent people skills, and a strategic approach to improving cash flow and minimizing bad debt.

Key Responsibilities:

  • Oversee Billing & Collection Operations: Lead all third-party billing functions to ensure timely receipt and posting of client payments, and actively manage the Qualifacts Revenue Cycle Management Services (RCMS) team to process accounts receivable and manage collections.
  • Revenue Cycle Management: Manage the day-to-day activities related to eligibility, credentialing, payer enrollment, billing, collections, and accounts receivables. Partner with external vendors and internal teams to ensure efficient, compliant, and accurate billing and revenue practices.
  • Denial & Payment Management: Implement robust denial management procedures to address and appeal denied claims, reducing future claim issues. Ensure accurate and timely payment posting and reconciliation of third-party claim payments.
  • Audit & Compliance: Conduct regular billing audits, ensuring compliance with CARF standards. Maintain up-to-date knowledge of billing and coding standards (CPT, DSM-5, ICD-10) and ensure they are applied consistently to maximize revenue.
  • Reporting & Analytics: Provide regular reports and trend analysis to executive leadership on revenue cycle performance, cash flow, accounts receivable status, and opportunities for improvement. Use data to drive business decisions and improve financial outcomes.
  • Credentialing & Contract Management: Oversee staff credentialing and enrollment with payers, ensure timely contract initiation and renewal, and stay informed of changes in payer requirements or reimbursement rates.
  • Process Improvement: Continuously assess systems and workflows, proposing and implementing process improvements to optimize revenue cycle operations. Work collaboratively with various departments to enhance interdepartmental communication, systems, and goal setting.
  • Compliance: Ensure compliance with federal, state, and HIPAA privacy and security regulations, and maintain provider enrollments with payers. Stay current on billing and reimbursement regulations to safeguard against potential revenue loss.
  • Client Services: Ensure a high level of customer service by addressing client billing inquiries, ensuring timely processing of client statements, and implementing measures to enhance client satisfaction.

Qualifications:

  • High School diploma or equivalent required; bachelor's degree in finance, healthcare administration, business, or a related field preferred (degree not required with additional, relevant work experience).
  • Must have a minimum of 5 years of relevant experience in healthcare revenue cycle management, including billing, collections, coding, and accounts receivable, preferably in a behavioral health setting. (If no degree, a minimum of 8 years of relevant experience is required).
  • Experience managing third-party billing and collections is a must.
  • Strong analytical and problem-solving skills, with the ability to leverage data to drive process improvements, address revenue cycle challenges, and enhance cash flow.
  • Compliance & Regulatory Knowledge: Deep understanding of healthcare billing regulations, HIPAA compliance, and payer contracts. Familiarity with CPT, DSM-5, and ICD-10 coding standards is required.
  • Excellent communication, conflict resolution, and customer service skills.
  • Bilingual (Spanish/English) proficiency is preferred but not required.

Technical Skills:

  • Proficiency in Electronic Health Records (EHR) systems
  • Experience with Practice Management Systems (PMS)
  • Familiarity with billing and coding standards (CPT, DSM-5, ICD-10)
  • Experience managing system functionalities (e.g., updating/adding procedure codes, fees, billing forms)
  • Competency in payment posting and reconciliation processes
  • Knowledge of Meaningful Use standards (preferred)
  • Proficiency in healthcare billing, reimbursement, and analytics tools
  • Familiarity with HIPAA privacy and security regulations
  • Experience with revenue cycle key performance indicators (KPI) tracking