Director of Revenue Cycle Management

Director of Revenue Cycle Management

Position Summary:

The Director of Revenue Cycle Management reports to the CFO and is responsible for overseeing and coordinating all revenue cycle activities with a goal of maximizing reimbursement in a cost-effective manner that is in compliance with federal, state and payer-specific billing requirements. The Director will oversee the overall policies, objectives, and initiatives of our healthcare facilities’ revenue cycle activities to optimize the patient financial interaction along the care continuum.

Duties and Responsibilities:

• Oversee and support the daily operations of all PFS functions, including charge captures, coding, billing, follow-up and collections, cash posting and health information management.
• Work closely with other departments (Case Management, Information Technology, Nursing, and Ancillary departments) to streamline procedures that will help ensure correct billing to patients and payers in a timely manner, thereby expediting hospital and clinic receivables.
• Oversee work schedule and direct changes in priorities and schedules as needed to assure work is completed in an efficient and timely manner and to improve the department’s performance and service.
• Direct the selection, supervision and evaluation of staff. Ensure performance evaluations are conducted in a timely manner according to policy and initiate disciplinary actions as warranted. Resolve grievances and other sensitive personnel matters in coordination with Human Resources.
• Oversee orientation and continuing education for all staff. Ensure mandatory and relevant training is provided to staff in a timely manner.
• Implement a Quality Assurance program for PFS functions and monitor staff and team performance, making changes, when required, to support accurate billing to payers and patients in a timely manner and compliance with laws and department procedures.
• Establish and maintain departmental policies and procedures. Communicate relevant information to other hospital departments. Establish controls and review mechanisms to ensure procedures are being followed correctly. Recommend policy changes to the Chief Financial Officer.
• Collaborate with Clinic Operations, Patient Access and Hospital Administration teams.
• Respond personally to concerns and/or complaints expressed by patients, visitors, hospital staff, and physicians in effort to support optimal operations and excellent customer service.
• Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Maintain appropriate internal controls for the safeguarding of cash.
• Follow and monitor compliance with hospital and clinic policies and standards.
• Develop, redesign, and monitor key performance indicators including payer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other requested parameters.
• Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.
• Serves as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implanting solutions.
• Monitor A/R effectively and ensure aging categories are within established goals.
• Responsible for maximizing the collection of medical services payments and reimbursements from patients, insurance carriers, and guarantors.
• In conjunction with operations, reviews and enhances insurance authorization, coding review, billing, collection, and payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current workflow.
• Monitors daily productions of claims, denials, and appeals.
• Monitoring aged accounts and verifying appropriate collections procedures are being followed.
• Ensures compliance with relevant federal, state, and payor-specific billing requirements.
• Regularly provides upper management with revenue cycle status including reports, metrics, and presentations.
• Ensure staff is educated on new technology, goals, and contracts.
• Establish a regularly scheduled revenue cycle meeting to discuss strategies and ensure everyone is educated on the direction of the department.
• Work with Managed Care vendors in identifying any payer relation issues or contracts that need to be renegotiated or negotiated for the first time.
• Any and all other projects, goals, issues surrounding the revenue cycle, conflicts or concerns as directed or indicated by Administration.

Required Qualifications:

• Bachelor’s degree in Healthcare Administration, Business, Accounting, Finance or related field and three years of management-level experience in both physician and hospital revenue cycle with expertise in billing and collections. Master’s degree preferred.
• Thorough knowledge of patient financial services (PFS) processes and standards related to billing, collections, and cash posting. General knowledge of patient registration, finance, and health information management.
• Knowledge of regulatory requirements related to patient accounting, including a solid understanding of Medicare, and managed care processes.
• Ability to work and communicate effectively with a diverse group of people including other department managers, staff, physicians, patients, and the public.
• Ability to read, analyze and interpret financial reports, contracts, and other legal documents.
• Outstanding ability to work independently to achieve results. Often, there is no precedent for and little help in carrying out assigned tasks. Must originate, plan, adapt and invent to accomplish tasks.
• Ability to set and maintain priorities when dealing with multiple demands and interruptions.
• Strong analytical and problem-solving skills.
• Dedication to the development of others and willingness to coach and mentor people as necessary to promote their personal and professional growth.
• Excellent customer service skills.
• Intermediate computer skills.

Physical Requirements/Working Conditions:

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 use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to stand and walk; occasionally required to stoop, kneel, or crouch. The employee is frequently required to sit for extended periods of time. The employee must regularly lift and/or move up to ten pounds, occasionally lift and/or move up to twenty pounds. Specific vision abilities required by this job include close vision, distance vision, color vision and adjust focus. The work environment is primarily an office setting.