Revenue Cycle Director

Description

Director of Revenue Cycle

Little Rock, AR

Description

Arkansas Urology

Director of Revenue Cycle

Job Description

Job Code:

Exempt: Yes

Department: Business and Billing Operations

Reports To: Chief Financial Officer

Location: Clinic and ASC

Date Prepared:

Date Revised:

GENERAL DESCRIPTION OF POSITION

The Director of Revenue Cycle is responsible for oversight of the Revenue Cycle Management activities to include billing, coding, estimates, and prior authorization departments, including policies, objectives, and initiatives within Arkansas Urology (AU) and Centerview Surgery Center (CSC).  This Director is also responsible for oversight of Scheduling operations of Centerview Surgery Center. 

  ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform the following satisfactorily; other duties may be assigned. 

1. To develop and implement policies and procedures for all stages of the revenue cycle to ensure maximum efficiency and compliance. 

2. Monitor key performance indicators (KPIs) and generate reports to track the effectiveness of revenue cycle activities. Determine appropriate and effective performance metrics and staff requirements for the department to run with efficiency, accuracy and outstanding customer service.

3. Utilize electronic health records (EHR) and revenue cycle management software to streamline operations and data analysis.

4. Develops all Revenue Cycle procedures and policies for AU and CSC with the approval of executive leadership.  

5. Stay abreast of changes in healthcare regulations, payer policies, and industry trends to adapt strategies accordingly.

6. Coordinate with other departments, such as compliance and finance, to ensure the integrity of financial reporting and adherence to legal and regulatory standards.

7. Resolve complex patient, physician and clinician issues related to charging, coding, documentation, and CSC Scheduling matters as necessary.

8. Promotes a team-oriented environment that fosters effective collaboration within and outside of the group.

9. Develops and updates staff training program. This includes educating clinical staff to increase the effectiveness and efficiency of clinical documentation to ensure the highest possible reimbursement for the services rendered.  

10. Maintains confidentiality in compliance with HIPAA regulations and ensures that department remains compliant with all relevant regulations.

11. Play a significant role in long-term planning, including an initiative geared toward operational excellence.

12. Works with the CSC Administrator to manage all aspects of CSC software 

13. Develop and maintain documentation audit schedule, completing at least 2 audits yearly.

14. Perform any other related duties as required or assigned.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty mentioned satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.

EDUCATION AND EXPERIENCE

Mental alertness and adaptability to office and field area work routines. Equivalent to four years high school or GED, with particular emphasis during high school in office skills, shop skills, or others, plus 5 years related experience and/or training. Or equivalent combination of education and experience.

COMMUNICATION SKILLS

 Ability to read, analyze, and understand common scientific and technical journals, financial reports, and legal documents; Ability to respond to complex or difficult inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write speeches and articles for publication that conform to prescribed style and format; Ability to effectively present information to top management, public groups, and/or boards of directors.

MATHEMATICAL SKILLS

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts such as fractions, ratios, and proportions to practical situations.

CRITICAL THINKING SKILLS

Ability to define problems collects data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

REQUIRED CERTIFICATES, LICENSES, REGISTRATIONS

Not indicated.

PREFERRED CERTIFICATES, LICENSES, REGISTRATIONS

Not indicated.

SOFTWARE SKILLS REQUIRED

Intermediate: Database, Spreadsheet

Basic: Alphanumeric Data Entry, Contact Management, Word Processing/Typing

INITIATIVE AND INGENUITY

SUPERVISION RECEIVED

Under administrative direction, setting up own standard of performance. Virtually self-supervising. Reports to senior management of the organization.

PLANNING

Considerable responsibility with regard to general assignments in planning time, method, manner, and/or sequence of performance of own work, in addition, the organization and delegation of work operations for a group of employees engaged in widely diversified activities.

DECISION MAKING

Performs work operations which permit frequent opportunity for decision-making of major importance which would have considerable effect on the final attainment of multiple major activities and the organization's projects of a large organization component and organization's clientele.

MENTAL DEMAND

Comprehensive and very intense mental demand. Comprehensive and continual involvement with multiple divisions, departments and/or organizations. Strategic and operational management functions which relate to both the short-term and long-term time periods.

ANALYTICAL ABILITY / PROBLEM SOLVING

General oversight. Activities covered by general organizational philosophy and objectives. Solving problems in novel, non-recurring or swiftly changing situations in which the approach is not fully defined. Guidance by top executive officer or business owner.

SUPERVISORY RESPONSIBILITIES

Supervises and manages multiple departments whose employees who are engaged in diversified activities related to the business and billing operations.

Oversees the following departments: Insurance Follow Up, Payment Posters and Coding.

Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.  Responsibilities include interviewing, hiring and training employees; planning, assigning and directing work; appraising performance, rewarding and disciplining employees; addressing complaints and resolving problems.

RESPONSIBILITY FOR FUNDS, PROPERTY and EQUIPMENT

Regularly responsible for funds, building premises, inventory, or other property owned, controlled, or leased by the organization and, in addition, may have temporary custody and responsibility of patron property, which through carelessness, error, loss, theft, misappropriation, or similar action would result in very important monetary losses to the organization. 

ACCURACY

Probable errors would normally not be detected in succeeding operations and may have serious effects in relationships with patrons and/or with the operations of other segments of the organization. Frequent possibilities of error would exist at all times, since the above mentioned areas are inherent in the job.

ACCOUNTABILITY

FREEDOM TO ACT

Oversight. High level of freedom to complete the duties of the position and guided by broad policy with oversight by president, elected official, etc

IMPACT ON END RESULTS

Major impact. Job has a considerable impact on the organization's end results. A high level of accountability to generate, manage, and/or control funds within a department and/or total organization.

PUBLIC CONTACT

Regular contacts with patrons where the contacts are initiated by the employee. Involves both furnishing and obtaining information and, also, attempting to influence the decisions of those persons contacted. Contacts of considerable importance and of such nature, that failure to exercise proper judgment may result in important tangible or intangible losses to the organization.

EMPLOYEE CONTACT

Establishes company culture by setting tone of interactions and communication with senior level internal officials and employees throughout the organization.

USE OF MACHINES, EQUIPMENT AND/OR COMPUTERS

Regular use of complex machines and equipment (desktop/laptop computer and software, road and production machines and equipment, etc.)

WORKING CONDITIONS

Normal working conditions as found within an office setting, wherein there is controlled temperature and a low noise level, plus a minimum of distractions.

ENVIRONMENTAL CONDITIONS

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

The noise level in the work environment is usually moderate.

PHYSICAL ACTIVITIES

The following physical activities 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 and expectations.

High diversity, low physical. Work activities which allow for considerable amount of diversity as an incumbent performs a variety of tasks. Such tasks might be performed from a given work area, or the individual may move about physically in performing a variety of duties.

While performing the functions of this job, the employee is regularly required to use hands to finger, handle, or feel, talk or hear; frequently required to sit; and occasionally required to stand, walk, reach with hands and arms, stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision; and color vision. 

ADDITIONAL INFORMATION

Job Knowledge, Skills and Abilities  

To perform the job successfully, an individual should demonstrate the following competencies to perform the essential functions of this position. 

10 years of experience working in the medical/healthcare billing area, with strong, demonstrated knowledge of managing claims processing.

7 years of leadership experience with demonstrated ability to recruit, assess, motivate & inspire others to help business achieve success. Leadership in accounts receivable or billing operations preferred. 

Deep familiarity with payer/insurance appeals and reimbursement processes, experience working in the insurance industry preferred.

Demonstrated knowledge and familiarization with the Medicare billing regulations and reimbursement methodologies.

Strong analytical and forecasting skills with demonstrated ability to plan workload, allocate tasks and scale operations to align with business priorities.

Strong organizational and problem-solving skills.

Adaptable, open to change and able to work in ambiguous situations and respond to new information and unexpected circumstances.

Strong interpersonal and teamwork skills including the ability to easily convey concepts and priorities as well as ability to solicit feedback and inputs.

Strong presentation skills with ability to convey information and adjust delivery as appropriate to the audience.

Demonstrate ability to inspire and motivate others and work effectively through influence and collaboration.

Supervisory Responsibility

Responsible for approx. employees from multiple departments.

Position Type/Expected Hours of Work

This is a full-time position. Days and hours of work are Monday through Friday, 8:00a.m. – 5:00 pm.  Must also attend after hour committee and board meetings as needed.  

Travel

Must be available for travel as needed for conferences.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.