Revenue Cycle Director

Posted Date: 12/18/2024

Job Location: St. Anthony Office Building, 1524 Hwy 30 East, PO Box 628, Carroll, IA, 51401
Department: Finance
Employment Type: Full-Time

Job Description

“Inspired by faith and committed to excellence.” St. Anthony employees follow a We are One culture while supporting the Organization’s mission, vision, and values.

Job Summary
Manages all functions of the organization’s billing and revenue cycle to maximize cash flow while maintaining and improving internal and external customer relations. In conjunction with the Chief Financial Officer (CFO), the Revenue Cycle Director will contribute to the day-to-day operations on all issues related to the revenue cycle function, provide analysis, create written processes and train others in implementing a cross functional revenue cycle.

Essential Duties and Responsibilities

Manages revenue cycle operations, including all aspects of registration, coding, prior authorization, charge-entry, claims submission, collections and payment posting.

Serves as the resident expert and “go to” person for all registration, coding, prior authorization, billing and collections processes.

Develops, reviews and enhances operating policies and procedures to improve quality and efficiency.

Maintenance of the organization’s charge master to maximize collection while maintaining competitive pricing.

Analyzes actionable claims data, including revenue and volume, by region, payor, physician, procedure code, etc.

Maintains and negotiates all payor contracting.

Ensures compliance with coding and billing regulations, relevant healthcare regulations and data privacy issues (e.g. HIPAA)

Prepares and reviews periodic reports of performance metrics with the revenue cycle.

Optimizes revenue cycle to maximize billing and collection.

Works with the Controller and CFO to complete the annual Medicare Cost Report.

Develop and review the budgets of all departments associated with the revenue cycle.

Promotes a supportive environment in which employees are encouraged to solve problems and address customer issues.

Practices and behaves in a professional, safe and ethical manner at all times.

Maintains friendly and courteous interpersonal communication skills and a positive service attitude.

Participates in performance improvement and educational activities.

Works willingly and accepts assignments as given.

Attends all mandatory meetings and programs.

Participates in opportunities that enhance personal and professional growth.

Performs other duties as necessary or assigned.

Complies with the Corporate Compliance Policy and all laws, regulations, and Standards of Conduct relating to the position and agrees to report any suspected violations of law or Standards of Conduct.

Complies with all applicable state and federal regulations and JCAHO standards.

Maintains a safe work environment using safe work practices, utilizing standard precautions and complying with hazardous waste procedures at all times as described in St. Anthony's Safety Manual.

Maintains the confidentiality of patient, resident, employee and organizational information.

Supervisory Responsibilities
Carries out supervisory responsibilities as designated by the Chief Financial Officer and in accordance with the organization's policies and applicable laws. Responsibilities may include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

Bachelor’s degree in healthcare administration, business or related field.

Minimum of five (5) years medical insurance/healthcare billing and collections experience with a deep understanding of medical billing rules and regulations.

Three (3) years supervisory or manager experience preferred.

A combination of education and experience will be considered.

Position Requirements, Certificates, Licenses, Registrations

Thorough understanding of medical billing, collections and payment posting, revenue cycle, third-party payers, Medicare; strong knowledge of Iowa and Federal payer regulations.

Well versed in CPT and ICD10 codes and procedural modifiers, claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal process.

Proficient in EMR software and Microsoft Office, including Outlook, Word and Excel.

Strong leadership, team development and business skills.

Excellent verbal and written communication skills.

Skills
Ability to read, interpret and take action as it relates to hospital operations. Ability to write correspondence in a professional and understandable manner. Ability to confidently and effectively present information in one-on-one and group situations to individuals inside and outside of the organization.

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; talk and hear; and use hands to finger, handle or feel. The employee frequently is required to reach with hands and arms. The employee frequently is required to stand and walk; occasionally required to stoop, kneel, or crouch. The employee is frequently required to sit for extended periods of time. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus.

Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Regularly works in an office setting with frequent interaction with employees, board members, donors, volunteers, and the public.

Due to the nature of business in a health care setting, although risk is minimal, any employee of St. Anthony may be exposed to moving mechanical parts, fumes or airborne particles, blood borne pathogens, unpleasant sights, odors, and/or materials in patient care and/or provider work areas.

The noise level in the work environment is usually quiet.

If you have further questions, please call the Human Resources Department at 712-794-5111.