Director of Prof Billing Services

Position Purpose

The Director of Professional Billing Services is responsible for the overall financial viability ensuring that Renown Health Services is appropriately reimbursed for all services provided within regulatory and contractual guidelines. This position directs leaders in the Revenue Cycle and will champion development of lean processes to ensure we have the best in class, patient focused revenue cycle operations with a metric driven, performance-based culture of accountability at all levels.

Nature and Scope

This position will provide coordination and subject matter expertise across all components of the revenue cycle for Health Services to ensure streamlined, cost-effective, patient-centric operations at the medical groups and affiliated entities. This position will make recommendations for improvement and initiatives to develop and implement new programs, system efficiencies and optimizations to improve services and operations. This position will track and benchmark Revenue Cycle metrics for Health Services against actual results while coordinating standard usage of all system reporting. Develop and make recommendations in the creation of capital and operating budgets. Present a business case to Vice President of Revenue Cycle regarding programs, projects or procedures that may reduce risk, improve efficiency, increase cash collections, reduce accounts receivable, motivate staff or in general benefit of the Professional Billing Department and all of Revenue Cycle. In addition, will have direct responsibility to plan, organize and implement process and business improvements on designated strategic initiatives.

Additional responsibilities include :

Expert knowledge of coding and billing guidelines and policies to provide education, development, and monitoring.

Ensure compliance with relevant regulations, standards and directives from regulatory agencies and third-party payers.

The position will ensure that appropriate internal control safeguards are maintained for provider credentialing, professional coding, health system billing, cash collections, accounts receivable records, and self-pay processes.

Develops implements and presents business operations and financial planning policies and procedures throughout revenue cycle.

Monitors and maximizes reimbursement through denial prevention and accounts receivable management.

Develops and implements departmental procedures, standards, tools, and techniques to effectively process claims and maximize collections.

Coordinates with Information Resources in the development, evaluation, and maintenance of information systems for electronic billings, electronic remittances, payer reimbursement, payer confirmation of claims, denial management, corporate compliance and collections to maximize reimbursement, provide peak performance and reporting.

Participates as a member of the subcommittee of the Corporate Compliance Committee. Supports the corporate compliance efforts through investigation, policy / procedure development and monitoring.

Provides vendor contract management and monitoring to ensure performance and productivity for Professional Billing Services.

Analyzes and presents data to the Vice President of Revenue Cycle and other senior management members regarding cash collections, accounts receivable, denial management and employee productivity.

This position is responsible for collaborating with operational leaders to provide timely accurate financial information with a focus on, results compared to stated goals, reduction in denied services and areas of opportunity.

The position will collaborate with inter-departmental teams to strengthen relationships with physicians and internal and external departments.

Develops the budget for the assigned departments, allocating funds within budget limits to accomplish departmental and health network objectives and goals. Monitors variances against budget on an on-going basis. Ensures accurate daily / monthly statistical and financial reports are compiled and necessary.

This position provides mentorship and development of staff to lead and engaged team.

This position does not provide patient care.

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications

Requirements - Required and / or Preferred

Name

Description

Education :

Must possess a strong proficiency in the English language, including the ability to read, write, and communicate effectively. A bachelor’s degree in a relevant field is preferred, though successful experience in a similar role may be considered in lieu of formal education. Preference will be given to applicants with a master’s degree in business, accounting, or finance, particularly with a concentration in healthcare.

Experience :

Requires five years of progressive experience in Revenue Cycle leadership, or a similar field, across multiple departments. Prior experience with and knowledge of process improvement, project management, planning, and financial analysis preferred.

License(s) : None

Certification(s) :

Nationally accredited certification in Coding and Compliance preferred.

Computer / Typing :

Must be proficient in Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and Word and have the ability to use the computer for online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.