Director of Revenue Cycle

Job Description

People's Health Centers

Job Description

Job Title : Director of Revenue Cycle

Department : Finance

Reports To : Chief Financial Officer

FLSA Status : Exempt

Prepared By : Chief Financial Officer

POSITION SUMMARY: This position will be responsible for the oversight and development of process improvement work to optimize people, processes and technology throughout the entire revenue cycle and must have in-depth knowledge of Missouri Federally Qualified Health Center (FQHC) and Certified Community Behavioral Health Clinic (CCBHC) revenue cycle, including scheduling, referral management, insurance verification, registration, charge capture, coding, claims processing, billing, collections, accounts receivable management, training and HRSA sliding fee scale requirements. This role will be responsible for driving the design and implementation of a sustainable collection optimization strategy.

The Senior Director will ultimately be responsible for designing, building, and managing an in-house RCM team, will work closely with outsourced revenue cycle partners and agents, as well as work closely with other cross-functional team members to ensure operational success of the overall agency by being the subject matter expert on the revenue cycle.

POSITION QUALIFICATION REQUIREMENTS

Education: Requires a master's degree in business administration, accounting, healthcare administration, or relevant field (Preferred). Candidates with bachelor's degrees or other relevant certifications from nationally recognized accreditation associations in the field with a recognized track record of success and experience may also be considered on a case-by-case basis in lieu of the degree requirement.

Experience: Requires 10 years' experience in direct revenue cycle management or progressive responsibility in a leadership position, leading teams and/or projects.

A minimum of 5 years' direct experience with FQHC, FQHC Look-alike, Community Health Center or CCBHC billing and coding.

Skills and Abilities which may be representative but not all inclusive of those commonly associated with this position:

1. Ability to think strategically about - and prioritize against - the entire revenue cycle.

2. Ability to decipher and determine the right data, KPI, etc. to use to make strategic, data-driven decisions.

3. Strong attention to detail and understanding of industry best practices related to RCM.

4. Ability to develop, implement, and maintain policies and procedures vital to the maintenance of a sustainable A/R position.

5. A strong team leader who can motivate and coach a team and allocate resources based on priorities.

6. Good written and oral communication skills including the preparation of statistical reports.

7. Good computer skills including the use of word processing, spreadsheet, database and e-mail software.

8. Ability to use or learn to use a variety of office equipment such as Medifax, copier, and ten key calculators.

9. Knowledge of billing and reimbursement of Medicaid, Medicare and other insurance.

10. Ability to use manuals and learn new computer software.

11. Ability to devise training materials to teach the computer health system.

12. Able to learn and make all changes in the electronic health record system.

13. Excellent Customer Service skills.

License(s)/Certification(s) Required: None Required

FUNCTIONS OF THE JOB

Essential Functions

1. Design, implement and monitor all key performance indicators to ensure that cash flow is optimized throughout the revenue cycle. Examples include reducing unbilled and denial cycle times and the timely resolution of billing, insurance collection, and denial issues.

2. Work with information technology and the data team to implement real-time dashboards and tracking of claims data and provider productivity (billing, collection, open claims by provider/department/ etc.)

3. Develop, plan, organize, and implement current and future best practices for revenue cycle billing, collections, client accounting and other functions. Continuously identify opportunities for improvement.

4. Oversee the eligibility of, and performance of program specific requirements including the sliding fee scale program and CCBHC programs, ensuring the appropriate spend down and reallocation of program funds and grants when necessary.

5. Collaborate and coordinate with practice leaders, health care providers, and departmental leaders to ensure registration, coding, billing and coding are performed in accordance with industry's best practices.

6. Work collaboratively with other leaders on revenue cycle performance to meet strategic goals, develop guidelines, policies, and procedures through the use of data analysis.

7. Coordinate and lead regular billing management meetings; conduct detailed review of key performance indicators and trends.

8. Maintain regular contact with representatives and their payment agents.

9. Maintain relationship with external vendors and agents related to revenue cycle to ensure compliance with contractual provisions and accuracy in billing.

10. Remain current on Medicaid and Medicare reimbursement policies and procedures and consult with appropriate representatives for problem resolution.

11. Provide updated information relating to third party reimbursement rates, policies, regulations and processing procedures.

12. Orient, train, and supervise all billing clerks and data entry personnel.

13. Assist insurance/billing clerks and data entry personnel when necessary.

14. Periodically review EOBs to detect potential problem areas.

15. Ensure that insurance claims are being filed on a timely basis.

16. Ensure that billing and data entry personnel are complying with related office policies.

17. Ensure that all billing and data entry personnel are cross-trained.

18. Attend seminars on billing and coding.

19. Other duties/responsibilities as assigned.

Supervises: FQHCRevenue Director, CCBHC Revenue Director, Billing Staff (billers and coders), Front Office Associates, and ACA Navigators.

Physical/Visual Activities or Demands: Physical/visual activities or demands that are commonly associated with the performance of the functions of this job.

Physical Activities: Sitting, talking, and hearing with some stooping and walking.

Visual Activities: Acuity of objects within 20 or less inches with a good field of vision.

Physical Demands: Ability to lift one pound or less with rare lifting over five pounds.

Machines, Tools, Equipment and Work Aids which may be representative but not all inclusive of those commonly associated with this position:

Telephone, copier, fax, calculator, personal computer/terminal, common application software.

Competency:

To perform the job successfully, an individual should demonstrate the following competencies:

Analytical - Collects and researches data; Uses intuition and experience to complement data; Designs workflows and procedures.

Design - Translates concepts and information into images; Demonstrates attention to detail.

Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.

Project Management - Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.

Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills.

Customer Service - Manages difficult or emotional customer situations; Responds promptly ot customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.

Interpersonal Skills - Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.

Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests;

Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed

Cost Consciousness - Conserves organizational resources.

Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment.

Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.

Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.

Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths & weaknesses; Analyzes market and competition; Identifies external threats and opportunities; Adapts strategy to changing conditions.

Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.

Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.

Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks.

Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

Safety and Security - Observes safety and security procedures; Determines appropriate action beyond guidelines; Reports potentially unsafe conditions; Uses equipment and materials properly.

Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.

Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.

Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals. Completes tasks on time or notifies appropriate person with an alternate plan.

Initiative - Volunteers readily; Asks for and offers help when needed.

Innovation - Displays original thinking and creativity; Meets challenges with resourcefulness.

Language Skills:

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Mathematical Skills:

Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Reasoning Ability:

Ability to solve practical and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Computer Skills:

To perform this job successfully, an individual should have knowledge of accounting software; Database software; Payroll systems; Electronic Health Record Software, Spreadsheet software and Word Processing software.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit. The employee is frequently required to talk or hear. The employee is occasionally required to stand and walk. Specific vision abilities required by this job include ability to adjust focus.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Signature of employee Date signed

Signature of department manager/supervisor Date signed

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