Sr. Director Rev Cycle

The Sr Director of Revenue Cycle is responsible for managing and supervising the central billing and collection operations, credentialing and contract management for service billing to ensure accurate and timely submission of claims, prompt collections and aggressive denial management. Effective and timely communication of department / program issues or success to practice managing partners and CFO. Ensures compliance with relevant laws, regulations, established company policies and compliance programs. Employee will share the vision and mission of PT Solutions.

ESSENTIAL FUNCTIONS :

• Responsible for maximizing the collection of medical services payments and reimbursements from patients, insurance carriers, financial aide, and guarantors
• Responsible for insurance eligibility processes, charge processing, claim submission and processing, payment processing, collections and accounts receivable management, denial management, reporting of results and analysis, concurrent and retrospective auditing, proper coding, credentialing, insurance contract review and oversight, customer services relative to revenue cycle, training and development relative to revenue cycle, analytics, and all other revenue cycle management activities.
• Responsible for management and negotiation of payer contracts to ensure PT Solutions is obtaining competitive rates for reimbursement of services provided.
• Responsible for credentialing of therapists with insurance plans to ensure reimbursement for services provided.
• Plans, organizes, directs and controls Patient Accounts billing to maximize collection of revenue and minimize bad debt, including monthly review of program aging, bad debt estimates, denial reports, etc.
• Makes use of management practices that include empowerment of staff, the provision of clear and concise expectations regarding duties assigned to employees, frequent feedback focusing on both positive and problematic aspects of work performance and other management practices that are consistent with Continuous Quality Improvement.
• Promotes and maintains harmonious and effective relationships and communications within the department and with other departments.
• Provides leadership support and technical oversight of billing and collection functions performed by staff.
• Management oversight of all revenue cycle functions related to the patient visit from point of entry to accurate adjudication of the patients’ accounts.
• Provide feedback to the operations team to drive improvements and reduce denials that impede collections activities.
• Specific areas of responsibility include Revenue Cycle Training, Credentialing Registration, Claims Management, Billing, Collections, Patient Insurance, Data Processing, Integrity of Patient Accounts, Accounts Receivable Management, practice management system file maintenance, payer contract management and third party revenue cycle vendors.
• Responsible for provider reimbursement programs, policies, and strategies to ensure unit cost controls meet or exceed corporate objectives for medical cost containment.
• Analyzes claims, utilization, and medical cost data.
• Develops strategic, cost effective programs, and makes system or network changes to enhance competitive position.
• Monitors aged accounts and verifies appropriate collections procedures are being followed.
• Manages revenue cycle projects at the Practice level, such as audits.
• Regularly provides upper management with revenue cycle status including reports, metrics, and presentations.
• Develops, monitors, and assesses business metrics in order to refine processes and improve efficiencies
• Establishes internal goals and identifies external benchmarks.
• Resolves escalated reimbursement issues with Payor’s Practice, for optimal management of accounts receivables.
• Acts as a catalyst of change and stimulates others to change.
• Manages implementation effectively.

Organizing and Implementation

Controller

Customer and Community Relations

Compliance / Quality Improvement

Professional Development

REQUIRED SKILLS and ABILITIES :

REQUIRED CREDENTIALS :