Revenue Cycle Director

Job Title: Director of Revenue Cycle  

Department: Admin-Clinical 

Supervisor: Chief Operations Officer

FLSA Status: Full-time, Exempt

Summary 

The Revenue Cycle Director will be responsible for the day-to-day planning, oversight, and maintenance of the complete Revenue Cycle workflow to achieve efficient and effective processes to appropriately maximize patient services revenue. He/She acts as the organizational revenue cycle subject matter expert and liaison for all other departments as related to revenue cycle metrics, systems, and results. The Revenue Cycle Director may be asked to lead projects as sponsored by the VP of Clinical Quality, Chief Medical Officer, Chief Operation Officer, or Chief Executive Officer. He/She will report monthly on revenue analytics, education/coaching opportunities and areas of concerns or escalations to identify and recommend improvements to maximize revenues and workflow. The Revenue Cycle Director will also supervise the Patient Access Team to maximize the patient and family experience.

Areas of Responsibility

Revenue Cycle Management:

• Responsible for managing the entirety of the revenue cycle processes, from initial patient intake/registration, through the patient encounter with the provider and to the final revenue collection from third party payers.
• Develops corporate revenue cycle dashboard to monitor, track and trend appropriate metrics to indicate areas of concern, improvement opportunities and overall results.
• Oversees the sliding scale component of the Federally Qualified Health Center (FQHC) to meet Health Resources and Service Administration (HRSA) rules and regulations.
• Monitors inbound telephone queues and minimize high wait times.
• Maximizes the collection of payments and reimbursement from patients, commercial insurance carriers, government agencies (Medicare, Medicaid) and guarantors.
• Monitors aged accounts and verifies appropriate collections procedures are followed.
• Identifies, analyzes and addresses challenges and/or breakdowns in the Revenue Cycle process.
• Develops and implements intake, charge capture and billing best practices by leveraging technology to automate and standardize processes. Works closely with billing vendor. 
• Collects and evaluates both internal and external data to identify quality management problems and suggest sound solutions, consistent with Revenue Cycle's operation standards.
• Provides strategic direction for analytic, reporting, and Revenue Cycle system support, including daily support and management of both core and bolt-on software applications used to manage the revenue cycle.
• Manages physician billing revenue cycle processes to ensure proper coding, daily charge reconciliation and minimizes open encounters
• Reviews and certifies accounts receivable revenue reconciliations & reporting for the health centers
• Assists in management of all day-to-day third-party A/R reconciliation activities
• Monitors open claims reporting on an ongoing basis, investigates aging claims and minimizes denials

Reporting:

• Conforms to all applicable HIPAA, Billing Compliance, HRSA, and safety policies and guidelines.
• Oversees the development and monitors/generates reports related to all revenue cycle areas.
• Produces reporting and provides analytic analysis of data to Revenue Cycle leadership and stakeholders at all levels of the organization.

Supervisory Responsibilities:

• Responsible for all facets of the Revenue Cycle function including strategic planning, goal setting, work performance monitoring and measuring, fiscal and budgetary management, operations and workflow management, human resources management, project management, risk management, continuous quality improvement, information management, communication and patient and family satisfaction.
• Evaluates staff performance and takes corrective action in accordance with departmental HR guidelines, including annual Performance Reviews.
• Conducts regular meetings with the Revenue Cycle team for purposes of education, goal monitoring, and feedback. Performs training and development functions.
• Promotes and establishes an atmosphere of continuous improvement throughout the department by motivating, coaching, and staff development through rounding, evaluation, and/or development / revision of policies and procedures.

Patient Interaction: 

• Manages "special situation" and/or higher complexity calls escalated by Patient Access Representative for resolution. 
• Assists in patient interaction when the VP of Clinical Quality and/or Chief Medical Officer are unable to handle.

Skills and Qualifications:

Minimum Requirements:

• Bachelor’s Degree in Business Administration, Finance, Accounting, Healthcare Administration or related field required.
• 5 years healthcare experience required, with a background in Patient Access, Billing or Revenue Cycle Management 
• Ability to work independently, problem solve and deliver to deadlines with minimal direction.
• Great attention to detail and accuracy
• Ability to excel in a fast-paced, team-oriented environment working on multiple tasks simultaneously, while adhering to strict deadlines
• Quality minded; motivated to seek out errors and inquire when something appears inaccurate
• Deep understanding of accounting principles.
• Excellent verbal and written communication skills
• A thorough understanding and ability to use a full suite of Microsoft Office 
• Excellent research, problem-solving and analytical skills as it relates to Revenue Cycle area of expertise.
• Ability to create alignment across several internal functions to achieve business objectives.
• Leadership, managerial, and team building skills.
• Experience with EClinical Works or other EMR systems
• Ability to handle numerous requests from internal and external sources in a courteous, professional and collaborative manner.
• Experience in streamlining processes, project planning, and public speaking.
• Demonstrated intermediate skills in A/R management, Customer Service, problem assessment, and resolution and collaborative problem solving in complex, and interdisciplinary settings including strong proficiency in healthcare and payer guidelines as it pertains to billing and reimbursement.
• Ability to work collaboratively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.
• Must be a motivated individual with a positive and exceptional work ethic.

 Preferred Skills and Qualifications:

• At least 2 years of direct supervisory experience 
• Certified Coder 
• CPA 
• Bilingual English/Spanish proficiency in a healthcare setting

LANGUAGE SKILLS: Must possess above average command of speaking and writing skills.
 
REASONING ABILITY: Must be able to exercise sound judgment and concrete thinking when on the spot decision making is required. Ability to seek supervision for emergencies and unusual circumstances. Must be able to participate in regularly scheduled meetings.

A list of physical demands, equipment, & work environment demands can be reviewed in Human Resources. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the employer.