JOB SUMMARY: The Director of Revenue Cycle will set the vision and strategy in support of critical revenue cycle initiatives and goals for all business lines including but not limited to Orthopaedics, Hospital, Pain Center, and Ambulatory Surgical Center. The incumbent will lead and manage complex revenue cycle projects – drive performance and provide overall direction and oversight of the functional areas that support the organization’s financial and operational goals. Ensures compliance with CMS regulations, OSS policies and standards for third party payors. Fosters and promotes a culture of excellence in customer service to internal and external clients. 

QUALIFICATIONS AND EDUCATION:

Education:

• Bachelor’s Degree in Business/Healthcare Administration. Master’s Degree highly desirable

Qualifications:

• Minimum of 10 years of experience in a healthcare setting with emphasis on revenue cycle operations
• Minimum of 3 years in a progressive management or supervisory position with proven track record of managing a team to achieve results
• Professional certification through HFMA, AAHAM, or MGMA required.
• Comprehensive knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, ICD-9 and 10, and HCPCS coding
• Knowledge in healthcare compliance, including privacy and security regulations, confidentiality laws, access and release of information
• Evidence of strong leadership skills with the ability to guide, direct, interact with direct reports and other management/staff
• Proven record of identifying and implementing process improvement opportunities
• Strong time management skills
• Demonstrated understanding of governmental quality programs and reimbursement impact
• Demonstrated experience in payer contract management, analysis and negotiation
• Collaborative skills to form strong working relationships with vendors, other departments, physicians and senior management
• Demonstrated experience in creating a balanced scorecard and effectively managing against it
• Strong change management capabilities
• Self-motivated, analytical individual who is a proven problem solver using quantified data and measurable results and sound conclusions
• Ability to successfully communicate and interact with all levels of individuals within the organization

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Provides focus and direction to the activities of the revenue cycle in providing analysis, monitoring operations and/or developing and maintain the systems utilized in patient accounting operations; develop policies, procedures and workflows related to revenue cycle functions
• Performs monthly review and analysis of Account Receivable
• Assesses revenue cycle performance in accordance with set goals and objectives and provides leadership to attain them.
• Interacts with the various departments that are impacted by the operations of revenue cycle management.
• Establishes standards and processes to ensure continuous improvement in the revenue cycle, develops and implements changes and enhancements
• Uses analytical approach to problem solving using quantified data and measurable results to reach sound conclusions

·Works collaboratively with all departments to ensure operational functions are aligned with strategic goals of the organization

·Builds trust and partnership amongst the team by enhancing engagement, addressing performance results and providing coaching and mentoring.

• Develop and deploy solutions necessary for achievement of key metrics
• Stays informed of guidelines and regulations governing billing and collections practices, ensures compliant revenue cycle operations
• Communicates ideas, instructions and information so they are clearly understood by others
• Identifies trends and their root causes within assigned inventory
• Serves as a role model to the overall company image
• Performs administrative duties fundamental to successful project operations
• Supports the annual planning process to establish objectives and performance measures that gauge the effectiveness and efficiency of organizational strategies

SUPERVISORY RESPONSIBILITIES:

Directly supervises Patient Financial Services Manager, Patient Financial Advocate Coordinator and Revenue Integrity Specialist. 

·Functions as a coach & mentor to the staff for whom this position is responsible.

• Participates in and/or supports the employment process in conjunction with the Human Resources Department.
• Submits requests for staffing needs on a thorough and timely basis, securing all necessary approval(s).
• Participates in the screening/interviewing process, making self available to meet the candidates’ needs to expedite the screening process.
• Develops and/or maintains on-going training programs/initiatives to enhance skills, knowledge and productivity of existing employees.
• Participates in training sessions as required and/or deemed necessary.
• Provides leadership and direction to the staff for whom responsible in order to maintain a work environment that promotes the creative development of ideas and allows employees to meet and/or exceed expectations and established standards of performance.
• Monitors and measures performance of those staff reporting to this position. Addresses concerns or weaknesses and takes appropriate action to ensure issues are resolved. Ensures that staff are working as efficiently, as accurately and as productively as possible.
• Ensures the compliance and/or oversees the compliance with all policies and procedures by staff. Recognizes exemplary compliance. Initiates appropriate corrective action in instances of noncompliance; secures required approvals before addressing with the staff.
• Makes decisions and takes actions essential to the daily operation of the work area(s) for which responsible.
• Researches major expenditures (including equipment, supplies and/or systems) and make recommendations to the appropriate member(s) of management for approval to purchase.

LANGUAGE SKILLS:

Ability to communicate effectively with staff, peers, physicians and the public. Ability to speak and understand English fluently.

PHYSICAL DEMANDS:

Light physical effort; some standing, walking, bending, reaching, stooping; manual dexterity to operate keyboard and other equipment; detail oriented; able to maintain a pleasant and courteous demeanor under all circumstances.

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.

WORK ENVIRONMENT:

Climate controlled environment with occasional periods of being outside.

The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and shall not be considered as a detailed description of all work requirements that may be inherent in the position.