Director of Revenue Cycle

PRIMARY DUTIES AND RESPONSIBILITES:

1)  Revenue Cycle Management (RCM):

a)  Develop and implement strategies to optimize revenue cycle performance.

b)  Identify and coordinate with the Director of Admin Services issues and process improvements related to front-end RCM, i.e. enrollment, eligibility, insurance verification, etc.

c)  Provide oversite and optimization of the E.H.R. system related to coding, billing, and claims processing.

d)  Oversee fee schedule and billing matrix updates to ensure compliance with Medicare, Medicaid, ASO, third party payer, and other requirements.

e)  Develop and implement strategies to reduce claim denials, ensure timely resubmission of denied claims, and maximize reimbursement.

f)  Monitor and ensure payment and collections processes are completed timely and comply with agency and external regulations.

g)  Implement strategies to reduce A/R days and improve cash flow by ensuring timely collection of payments.

2)  Reporting & Analysis:

a)  Generate and analyze revenue cycle reports to identify trends and make data-driven decisions.

b)  Develop and monitor processes and KPIs related to denials management.

c)  Develop and oversee reports, processes, and KPIs to assist AR team in managing A/R days.

d)  Conduct financial analysis to assess the effectiveness of revenue cycle functions and recommend improvements

e)  Conduct regular analysis of accounts receivable to identify potential doubtful accounts and determine appropriate allowance levels

f)  Collaborate with senior management to develop and implement strategic plans for revenue cycle management.

3)  Grants and Contracts:

a)  Manage payer contracts and assist with negotiations to secure favorable terms and rates for services provided.

b)  Review contracts and grants to ensure compliance with all relevant regulations and standards

c)  Coordinate with credentialing team to ensure payer / employee rosters are accurate and updated.

d)  Oversee the invoicing process for contracts and grants, ensuring accurate and timely billing to secure funds and maintain compliance with funding requirements.

4)  General Ledger:

a)  Accurately maintain and balance general ledger balance sheet accounts associated with accounts receivable to the E.H.R.

b)  Accurately maintain and balance general ledger revenue and deductions from revenue accounts to the E.H.R.

c)  Ensure monthly cash reconciliations between E.H.R. and general ledger are completed.

5)  Provides management to departmental staff:

a)  Contributes to development of the budget; maintains and monitors the departmental budget.

b)  Determines the most effective method for assigning responsibilities and duties to department employees.

c)  Maintains job descriptions, procedures and other documentation related to the organization of the department.

d)  Assigns duties and responsibilities, and ensures employees receive instruction/training needed to complete their job responsibilities.

e)  Ensures that employees are aware of and adhere to all company policies and procedures and conveys all senior management communications and directives.

f)  Reviews departmental work for thoroughness and accuracy and provides specific instructions to supervisors and employees on completion of tasks/responsibilities.

g)  Prepares and conducts performance evaluations for departmental staff:

h)  Conducts hiring, disciplinary, and termination procedures

6)  Attendance and punctuality

a)  Ensures attendance and hours worked are accurately recorded in computerized timekeeping system

b)  Properly manages paid time off (PTO)

c)  Responsible for regular, predictable attendance and to work hours as scheduled, which may include evenings or weekends

d)  Approve supervisee timecards by set deadlines

Education/Experience Requirements

-Experience: minimum of 5 years of experience in revenue cycle management.

-Knowledge: In-depth understanding of healthcare billing, coding, claims processing, denial management, accounts receivable management, and reimbursement processes.