What are the responsibilities and job description for the Director of Revenue Cycle Management position at Absentee Shawnee Tribe of Indians of Oklahoma?
This position is currently open.
Public?:
Public
Division:
Health
Reports To:
Director, Executive
Type of Position:
Regular Full Time
Location:
Little Axe Health Center / 15951 Little Axe Dr. / Norman, OK 73026
General Description
The Director of Revenue Cycle Management reports to the Health Executive Director to ensure compliance with all regulations, policies and procedures related to the revenue cycle for facility charges and physician services. The Director of Revenue Cycle Management reviews systems and processes to identify potential compliance issues, works with appropriate departments to correct such issues, serves as the internal resource for billing-related questions, provides training related to the business office. The Director of Revenue Cycle Management will oversee, enhance, and maintain a properly functioning revenue cycle process through staff development, work integrity and team performance. This position is also responsible for managing and auditing the ongoing daily operations of a section of the Health System’s Revenue Cycle. This position will collaborate with leadership across multiple departments on all applicable projects. This position is responsible for the management and analysis of revenue cycle initiatives, teams and functions. Oversees and assists with compliance audits and investigations with a primary focus on revenue cycle by reviewing medical records for documentation compliance for CPT, HCPCS, and diagnosis codes determining that regulations are being complied with as evidenced in medical records documentation; and evaluating appropriateness of billing and coding procedures. Maintains and promotes all organizational and professional ethical standards. Works autonomously under general supervision with considerable latitude for initiative and independent judgment. The Director of Revenue Cycle Management also oversees Patient Registration, Business Office and Patient Benefit Advocates.
Responsibilities & Duties
Oversee Business Office staff, Patient Registration, and PBAs, managing revenue cycle operations, including training, auditing, billing, claims, collections, productivity, and performance reporting.
Act as a resource for documentation, coding, claim review process, and billing questions for all Health Systems by staying up-to-date with local, state, federal laws, regulations and guidelines, as well as monitoring payer bulletins, periodicals and web-sites to maintain revenue cycle knowledge.
Perform coding quality audits (monthly or weekly) of medical records to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines, CPT guidelines and health system policies and procedures.
Ensure full patient revenue capture across charge-generating areas, oversee charging mechanisms, facilitate seamless clinical handoffs, optimize strategic pricing, manage denials, billing, and strengthen clinical operations coordination.
Oversee fee schedule maintenance and enhancement by analyzing departmental charges, identifying and implanting charge improvements, assisting individual departmental with reconciling charge discrepancies, and determine the reimbursement impact of CPT revision.
Review of monthly reports to provide educational feedback on areas of possible documentation improvement to staff and providers.
Provide on-going education, communication and meets with each medical coder and biller to review the results of each audit and provides feedback to resolve issues found in the audit with re-training or other educational methods.
Assess changes in the regulatory environment; researches, investigates and responds to issues related to documentation, coding and billing.
Implement changes in workflows and queues with the goal of improving Absentee Shawnee Tribal Health System’s compliance in all aspects of operations, effectiveness and efficiency in billing and coding processes.
Revise, change, edit and monitor workflow with the goal of determining best practices to result in compliance and maximization of revenue.
Perform Gap Analysis of all the Revenue Cycle departments and makes recommendations for process improvements and training.
Design, analyze, and implement information and reporting systems to monitor, detect and correct variations in revenue cycle performance.
Resolve escalated issues that arise from operation and require coordination with other departments.
Follow changes and policies within the industry, preparing plans and goals to grow with the changes; follow company policy changes and projections that may impact Absentee Shawnee Tribal Health System’s services and programs.
Administer and uphold all of the Health System’s policies and procedures; recommend changes and/or creation of policies and procedures to enhance compliance and revenue management.
Communicate with Company’s employees and potential Business Associates as needed.
Assist with strategic sessions with management and health board of director to promote cost effectiveness of practices and procedures.
Provide leadership with a monthly analysis and summary using industry standard key performance indicators of excellence.
Ensure collection and A/R goals are achieved.
Oversee, write, and implement rules for the claims scrubber to minimize the number of times claims must be touched for billing processes.
Report all risks identified within the revenue cycle process.
Identify all variable at onset which may affect revenue cycle both positive and negative, developing a strategic plan to either mitigated disruption or capitalize on improvement.
Assist in preparation of reports to share with payers when discrepancies in reimbursement are uncovered.
Establish audit trails for investigation of adjustments, refunds, write-offs and collection efforts by internal and external audit firms.
Develop and maintain denial reports to use for root cause analysis of denials.
Prepare reports or presentations to share the results of denial analysis with affected areas.
Research, identify and analyze the impact of potential process changed after completion of root cause analysis of denials.
Attend meetings and in-service as requested.
Assist in producing, editing, revising various documents such as but not limited to; policies and procedures, job responsibilities, job expectations, performance appraisal forms, surveys, etc.
Train additional team members.
Attend continuing education activities to maximize knowledge.
Maintain needed education and certifications.
Participate in quality improvement programs as necessary.
Continuously works towards the Health System’s goal and vision.
Perform other related duties as assigned.
Education Requirements and Qualifications
Education and Qualifications
Bachelor’s degree from an accredited college in relevant subject such as business or healthcare preferred.
Experience in lieu of education may be considered on a year for year match.
Ten years of experience in management of clinical billing or healthcare revenue cycle experience required with extensive knowledge of ICD-10-CM and CPT coding principles and guidelines.
Extensive knowledge of federal regulations and policies pertaining to documentation, coding, and billing.
American Academy of Professional Coders certifications: CPC, CRC, CPMA, RCMS, CPCO preferred.
Requires knowledge of CPT, Level II HCPCS, diagnosis coding, and government payer regulations.
3 year experience working with Healthcare system database preferred.
Must have a working knowledge of reimbursement regulations for all carriers especially Medicare, Medicaid, and Managed Care.
Previous experience working with Native American entity preferred.
Extensive knowledge of revenue cycle and compliance procedures.
Considerable knowledge of industry laws, regulations and policies.
Ability to establish and maintain positive relationships with employees, management, clients, vendors and external contact.
Knowledge of local, state and federal regulatory requirement related to the functional area.
Must know how to perform proper revenue and reimbursement capture.
Knowledge, Skills and Abilities
Must be highly analytical, detailed, and independent.
Proven communication, organizational, and leadership skills required.
Knowledge and understanding of the credentialing process.
Ability to organize and prioritize work and manage multiple priorities.
Excellent verbal and written communication skills including, letters, memos and emails.
Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization.
Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
Ability to conduct and interpret qualitative and quantitative analysis, fictional analysis, healthcare economics and business processes, information systems, health care delivery systems, and project management.
Ability to provide leadership and influence others.
Ability to foster effective working relationships and build consensus.
Ability to mediate and resolve complex problems and issues.
Ability to develop long-range business plans and strategy.
Ability to mentor, foster and develop future management within the organization.
Maintain integrity of the billing system and processes.
Communicate effectively to manage employees directly and indirectly, producing optimal results.
Ability to build a highly effective team.
Must have a valid Oklahoma Driver’s License.
Must be able to pass a background check and drug test.
Physical Requirements and Working Conditions
Must be able to sit, stand, stoop, bend or kneel for long periods of time.
Prolonged sitting, standing, or walking; occasional bending, squatting, kneeling, and stooping; good finger dexterity and sensory perception; frequent repetitive motions; as well as talking, hearing, and visual acuity are required.
Frequent lifting (up to 15 lbs)
Occasional lifting (up to 30 lbs)
The Absentee Shawnee Tribe of Oklahoma (AST) is committed to Equal Employment without regard to race, religion, color, gender, national origin, age, disability, or sexual orientation. However, in accordance with the Indian Preference Act (Title 25 U.S. Code 472 and 473) preference in filling vacancies are given to qualified Indian candidates. AST will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990 and its amendments.
Native American Preference/EEO/Drug Free/Smoke Free Workplace
Posted Date:
1 day 52 min ago
Tribal Preference/Native American Preference/EEO/Smoke Free/Drug Free Workplace
Indian preference applies to all positions, but all resumes will be accepted.
Forward Completed Absentee Shawnee Tribe applications with resume to:
Absentee Shawnee Tribe
Human Resources Department
2025 South Gordon Cooper Dr.
Shawnee, OK 74801
Fax: 405-273-2710
Email: HR@astribe.com
