Director, Revenue Cycle

Starting rate is $49.19 per hour, with higher rates available based on experience.

Primary Purpose: The Director of Revenue is responsible for the direction and leadership, the day to day operations of the revenue cycle of Cass Regional Medical Center, to include registration, scheduling, coding and billing for all services of the hospital to include physician services. This involves services for Critical Access Hospital, provider-based clinics and provider based rural health clinics. Reports to the Chief Financial Officer.

Formal Policy-Setting Responsibilities: Formally responsible for creating and reviewing policies associated with the job’s purpose and essential responsibilities.

Routine Decision Making: Formally responsible for the daily functions of registration, scheduling, coding, medical records and billing ensuring Cass Regional Medical Center values.

Formal Supervisory Responsibility: The supervision of 3 coordinators and associated staff of the Patient Access, HIM and Business office departments to include registration clerks, schedulers, authorization clerks, information desk, PBX, coders, ROI and medical records clerk, and patient account representatives,

Required Knowledge: Knowledge of state, federal, and CMS rules and regulations, to include Critical Access Hospital services; professional services in rural health clinic, provider based clinics, billing standards for facility and professional services; complete understanding of CPT and ICD-10 coding to include modifiers, condition codes, revenue codes and NCCI edits, electronic medical records requirements, and insurance policies; complete understanding of the UB editor, LCD/NCD policies, and understanding of interfaces between software applications.

Uses the Cass Regional Medical Center’s Pillars of Success: People, Quality, Customer Service, Financial Strength and Growth to establish expectations for the employees of the Revenue Cycle Team, ensuring compliance of Joint Commission and CMS guidelines.

• Oversees the patient access procedures for accurate scheduling and registration process.
• Oversees coding and medical records procedures ensuring HIPAA compliance.
• Oversee business office procedures ensuring compliant billing and timely denial management. Oversee insurance payer enrollment and revalidation done on a timely basis, to ensure participation in network of each provider, clinic and hospital in every insurance plan.
• Ensures staffing is appropriate for optimum patient satisfaction.
• Develops employee satisfaction goals and follows through with actions to ensure employee satisfaction improvement.
• Work schedules are reviewed daily to ensure staffing is appropriate for optimum patient satisfaction. Creates processes for efficient and timely completion of duties.
• Job descriptions and performance evaluations are reviewed yearly addressing changes in processes.
• Initiate disciplinary actions as warranted. Resolve conflict and other sensitive personal matters timely.
• Oversee orientation and continuing education for all staff. Continuing education is provided in a timely manner.
• Provides rounding and staff meetings as recommended by Leadership.
• Ensure performance evaluations are conducted timely according to hospital policies.
• Addresses patient concerns and Press Ganey reports timely, exhibiting the Cass Regional Values.
• Addresses insurance denials with insurance provider representatives and HCA as needed.
  
  

B. Works closely with other departments (Case Management, Information Technology, Nursing, and other ancillary departments to streamline procedures that will ensure billing to patients and payers in a timely manner, thereby expediting hospital receivables

• Participates in hospital committees: MSQA, ECMS, Patient Concerns, PI, Financial Assistance and Revenue Cycle.
• Creates PI project and reports to the Performance Improvement Committee.
• Acts as Chairman of the Revenue Cycle and Financial Assistance Committee.
• Serves as the subject-matter expert on regulatory, compliance and legal requirements associated with medical billing and CMS guidelines. Ensures compliance with relevant regulations and directives from regulatory agencies and third party payers.
• Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding and reimbursement problems, and suggesting and implementing efficient processes.
• Establish and maintain departmental policy and procedures.
  
  

C. Monitors and reports status of the accounts receivable and ensures aging categories are within established goals and national benchmarks.

• Develop and monitor key performance indicators including payer mix, A/R collection rates, adjustments, bad debt, denial and appeal success rates and other requested parameters.
• Reviews and reports denials, creates processes to improve denial management.
• Creates reports for yearly reporting, DSH, bank audit, WPS cost report, Medicare Credit Balances.
• Creates and monitors budget and monitors department expenditures, process invoices timely.
  
  

Required Skills And Ability

Management skills: Ability to develop staff, coach and mentor people to promote their personal and professional growth. Ability to work and communicate effectively with a diverse group of people including department managers, physicians, patient and public. Strong verbal and written communication skills.

Financial: Must be able to create, read, analyze and interpret financial reports, contracts and legal documents.

Operational: Must have strong verbal and written communication skills, ability to prioritize, multitask and work independently, excellent problem-solving skills, knowledge of computer functions and interface

Education and Certification required for the position: Bachelor’s degree in Healthcare Administration, Business or Finance, or 3-5 years of management-level experience in hospital revenue cycle with expertise in coding, billing and collections is preferred.