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Revenue Cycle Director

2 months ago

Fort Myers, Florida, United States Orthopedic Specialists of SW Florida Full time
Director of Revenue Cycle Operations

Orthopedic Specialists of SW Florida is seeking a highly skilled and experienced Director of Revenue Cycle Operations to oversee and optimize the operational aspects of our Billing Department. As a key member of our team, you will play a crucial role in maximizing revenue through innovative and effective processes.

About Orthopedic Specialists of SW Florida

We are a leading orthopedic care provider in the Fort Myers area, with a team of 16 fellowship-trained orthopedic surgeons specializing in various subspecialties. Our state-of-the-art facility incorporates the latest technology to provide optimal care for patients with bone, joint, muscle, and spine problems.

Responsibilities
  • Manage medical billing, insurance, and patient collections, as well as related support activities.
  • Develop the strategic vision for revenue cycle management, select third-party billing partners, and execute billing initiatives.
  • Fine-tune operating activities to optimize revenue collections and develop key service and support metrics.
  • Work closely with executives, directors, physicians, and managers, as well as third parties.
  • Manage all billing programs, systems, processes, and third-party vendors to ensure accurate, timely, and well-controlled activities.
  • Prepare daily, weekly, and monthly RCM reporting metrics to remediate any items outside established KPI.
  • Effectively implement denial management reduction through process improvements and coordinate with internal teams and offices.
  • Maintain understanding and communicate payor policy changes across the market.
  • Responsible for Worker's compensation relations and statutory changes.
  • Promote positive attorney relations, stay current with PIP laws, and negotiate personal injury case settlements.
  • Meet with payor representatives for timely remediation of large denial or underpayment projects.
  • Formulate and execute policies and procedures to ensure the billing workflow is highly effective.
  • Daily reviews of incoming claim/denial volumes, daily billing, rejections, evaluate clean claim rates, and team workflow.
  • Presents first-line negotiation of payer contracts on an annual basis to the CEO and CFO.
  • Evaluate and communicate fee schedule changes, or changes that affect payments annually.
  • Annual charge master analysis and implementation.
  • Develops quality control program to meet the company's quality initiatives.
  • Ensure productivity goals are monitored and quickly re-mediates barriers to achieving those goals at the individual and/or team level.
  • Counsels and disciplines employees in accordance with department goals and policies.
  • Maintain compliance with directives from all regulatory agencies and third parties.
  • New provider onboarding, train on billing processes, also working in coordination with credentialing supervisor.
  • Ensure staff compliance with coding, PCI, insurance company policy changes.
  • Collaborate with other departments to maximize training and efficiency.
  • Maintain department compliance with state and federal regulations.
  • Required to attend all executive meetings.
  • Attend conferences pertaining to orthopedics or billing at the discretion of the CFO.
Requirements
  • 10+ years of managerial experience in healthcare revenue management cycle roles with experience in all phases of the revenue cycle management. Orthopedic experience preferred.
  • Experience with Modernizing Medicine EMR and billing system preferred.
  • Experience with a large group, growing healthcare organization support.
  • Extensive knowledge of patient registration, coding, billing, regulatory requirements, billing compliance, business operations, financial systems, and financial reporting.
  • Strong work ethic, attention to detail, knowledge of the claims process, coding, billing, collections, and credentialing.
Benefits
  • Competitive Pay
  • Generous PTO Allowance
  • 6 Paid Holidays
  • 401K
  • Affordable Medical, Dental, & Vision Insurance and more