What are the responsibilities and job description for the Director of Revenue Cycle position at Little Leaves?
Company Overview:
Positions Supervised (Direct Reports):
This position is responsible for the success of the revenue cycle management function, closely managing all billing, prior authorizations, and credentialing team members. The position will constantly analyze and optimize processes, perform root cause analysis of claim denials, and maximize both client satisfaction and revenue. They will also develop metrics and reporting that relate to authorization management, credentialing, contracting and the revenue cycle at Little Leaves, while ensuring compliance with all applicable regulations.
Responsibilities:
Essential Job Functions:
- Develop objectives and key results related to RCM functions
- Drive optimization and standardization of processes to meet or exceed objectives
- Utilize revenue cycle analytics platforms, including dashboards and reporting tools, to improve short-term outcomes and develop long-term goals
- Partner with organizational leadership to ensure appropriate staffing levels and optimal balance of workload
- Partner with cross-functional leadership and key stakeholders in analysis of claim denials, underpayments, compliance risks, client satisfaction, client financial counseling, and change management procedures
- Partner with Accounting to reconcile each month the practice management system and general ledger
- Ensure compliance with all applicable billing regulations, payer guidelines, third-party regulations, and Little Leaves standards
- Actively seek out and implement process improvement opportunities
- Develop and implement strategic plan to address accounts receivable aging, including utilizing industry benchmarks and other available resources to set and achieve goals
- Drive innovation in economic and clinical performance as it relates to revenue cycle
- Develop and implement internal audit processes and performance criteria for all revenue cycle roles to support reaching goals and metrics, using results to identify training opportunities
- Provide revenue cycle leadership representation on committees and special projects
- Develop and maintain revenue cycle written standards, standard operating procedures (SOPs), and other policies and practices to achieve high performance objectives (e.g. DSO, provision rate, denial rate, etc.)
- Facilitate a partnership between revenue cycle and other internal management teams that optimizes coverage and reimbursement for services rendered
- Consistently demonstrate a high level of integrity, responsibility, accountability, teamwork and ethics
- Follow all Company policies and procedures and serve as a model for others to follow such policies and procedures
- Performs other duties, as requested
Positions Supervised (Direct Reports):
- Billing & AR Team
- Authorization Team
Skills, Abilities, and Other Requirements:
- Experience in establishing internal controls across functions and quality controls within functions
- Experienced in health insurance contracts, authorizations and coding, i.e. CPT, HCPCS, ICD-10
- Excellent communication and presentation experience
- Experiences in accounting transactions, general ledger maintenance and reconciliations
- Understanding of HCFA 1500 insurance claims processing via electronic data interchange (EDI)
- Experience setting up and maintaining Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT)
- Understanding of insurance claim rejections and denials and appropriate resolutions
- Understanding of best practices in billing and collections
- Experience setup and maintenance of practice management systems
- Ability to identify issues in systems or processes and work with the team to resolve effectively
- Understanding of revenue cycle reporting and metrics
- Exercise confidentiality and discretion pertaining to the work environment
- Sensitive to working with an ethnically, linguistically, culturally, and economically diverse population
- Demonstrate high commitment to excellent customer service
- Demonstrate flexibility and ability to reprioritize
- Commitment to functioning as a team player
- Maintain required trainings
- Must clear DOJ/FBI background check and exclusion screening process, prior to and during employment
Minimum Education or Training Equivalent to:
- Master’s degree from an accredited college or university in one of the following disciplines: accounting, healthcare management or business management, preferred
- Bachelor’s degree from an accredited college or university in one of the following disciplines: accounting, healthcare management or business management, required
Minimum Additional Related Experience:
- Ten or more years of experience in revenue cycle management or accounting/finance in the healthcare industry, preferred
