Director, Revenue Cycle

JOB OVERVIEW

The Director, Revenue Cycle Management is responsible for the day-to-day management of the Revenue Cycle Management Billing function and supervision and training of Revenue, Finance Liaison, and Billing Specialists staff. The role will ensure the accuracy, reliability, and timeliness of all Revenue submissions, collections, reporting, and all information generated by the revenue cycle function. This position works directly with network partners and finance liaisons to ensure successful implementation and execution of Healthy Alliance Social Care Network (SCN) Health-Related Social Need (HRSN) Services billing requirements.

RESPONSIBILITIES AND DUTIES

• Performs and supervises Finance Liaison and Billing Specialist staff in the Healthy Alliance Revenue billing cycle management. This includes, but is not limited to, billing Medicaid, MCO, and all other related SCN billing activities.
• Performs and manages entering, maintaining, and updating all information in internal and external electronic billing data base systems regarding community members, service providers, procedures, rates, agency cost center, and agency codes and other relevant information necessary to complete Revenue Cycle Management for the agency.
• Responsible for review, management, and transmission of Revenue Cycle Management billings.
• Management of remittance advices and the posting of such in the internal and external electronic billing systems.
• Assures maximation of cash collections through diligent and timely monitoring of all open accounts receivable balances; review cash receipts and EOBs to ensure that all charges are being properly billed and paid.
• Monitor partner SCN HRSN billable claims and assure follow up of denied claims including, but not limited to, correction, rebilling and collection of claims.
• Assure that all the organizations billing practices are in compliance with relevant regulations and standard, including federal (ex HIPAA) NYS DOH (ex Medicaid and related waiver programs, Medicaid managed care) and NYS insurance regulations.
• Manage finance onboarding and training support for Healthy Alliance’s SCN HRSN network with Healthy Alliance training department.
• Oversee SCN HRSN billable service submissions for timely submission and completeness, following up with the CBO finance point of contact, MCO’s, and, Medicaid as needed.
• Review and cross-check CBO invoices in Millin RCM to ensure Finance completes accurate payments in Bill.com.
• Review and reconcile PMPM (Per Member Per Month) payments in Millin.
• Review partner capacity building expense documentation, review for appropriateness and completeness before they are submitted for payment.
• Collaborate with internal cross-functional teams to meet partner needs and ensure positive partner experience.
• Hold weekly check-in meetings with finance liaisons, billers and partners.
• Identify partner needs and connect to appropriate Healthy Alliance stakeholders.
• Use Healthy Alliance tools and resources to inform partner communications and meetings.
• Track and communicate monthly partner financial performance to internal and external stakeholders.
• Exercise discretion and professional judgement to maintain project specific timelines and communicate project expectations and timelines with internal and external stakeholders.
• Embody Healthy Alliance’s vision, mission, and goals.

This job description is not designed to cover or contain a comprehensive listing of task activities and/or duties that are required of the employee for this job. Responsibilities and activities may change at any time with or without notice.

QUALIFICATIONS

Education

• Bachelor’s degree in a related field or equivalent experience such as accounting or business-related fields.

Specific Skills and Experience

• Minimum bachelor’s degree
• Minimum 10 years' work experience in government/healthcare payor billing and revenue cycle management to include Medicaid and MCO (Managed Care Organization like Fidelis).
• Excellent written and verbal communication skills for all levels of management.
• Strong working knowledge of Office 365 Suites in addition to moderate technical and analytical skills to compile data for planning and reporting purposes.
• Analytical thinker, able to plan for growth and execute.
• Ability to manage multiple detailed projects simultaneously and adjust as needed.
• Ability to identify the source of a problem and propose a timely solution within budget.
• Strong leadership skills to guide and direct a team.
• Demonstrated commitment to the values of diversity, inclusion, and equity.
• Strong community awareness and astuteness.
• Physical abilities: sedentary work that primarily involves sitting/standing, use of typical office equipment such as a computer, laptop, and cell phone. May include light work that includes moving objects up to twenty (20) pounds independently or with assistance.