Director of Revenue Cycle

We are seeking a dynamic leader to serve as the Director of Revenue Cycle, overseeing the comprehensive management of our healthcare revenue processes. This pivotal role involves directing all aspects of billing, coding, collections, and accounts receivable functions to optimize revenue generation while ensuring compliance with healthcare regulations. The ideal candidate will drive operational excellence, foster team collaboration, and implement innovative strategies to streamline revenue cycle activities across multiple departments.

Responsibilities

• Lead and manage the entire revenue cycle process, including medical billing, coding, claims submission, payment posting, and collections.
• Work closely with other departments to streamline procedures that will help ensure correct billing to patients and payers in a timely manner.
• Oversee work schedule and direct changes in priorities and schedule as needed to assure work is completed in an efficient and timely manner and to improve the department’s performance and service.
• Establish and maintain departmental policies and procedures. Communicate relevant information to other departments. Establish controls and review mechanisms to ensure procedures are being followed correctly. Recommend policy changes to the management team.
• Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Follow and monitor compliance with agency policies and standards.
• Develop, redesign, and monitor key performance indicators including payer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other requested parameters.
• Maintain extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.
• Serve as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Develop and maintain internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implanting solutions.
• Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks.
• Responsible for maximizing the collection of services payments and reimbursements from insurance carriers, and contracted facilities.
• In conjunction with operations, reviews and enhances insurance verification, coding review, billing, collection, and payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current workflow.
• Monitor daily productions of claims, denials, and appeals.
• Analyze claims, utilization, and cost data.
• Monitor aged accounts and verifies appropriate collections procedures are being followed.
• Ensure compliance with relevant federal, state, and payor-specific billing requirements.
• Regularly provide leadership with revenue cycle status including reports, metrics, and presentations.
• Ensure staff is educated on new technology, goals, and contracts
• Establish and conduct regularly scheduled revenue cycle meetings to discuss strategies and ensure everyone is educated about the direction of the department.
• Work with Managed Care vendors in identifying any payer relation issues or contracts that need to be renegotiated or negotiated for the first time.
• Other duties as assigned by leadership.

Requirements

• Bachelor’s degree in Healthcare Administration, business, accounting, finance, or a related field or a combination of education and experience.
• Thorough knowledge of standards related to billing, collections, and cash posting. General knowledge of patient registration, finance, and data processing.
• Knowledge of regulatory requirements related to patient accounting, including a solid understanding of Medicare, Medicaid and managed care processes.
• Ability to work and communicate effectively with a diverse group of people including other department managers, staff, physicians, patients, and the public.
• Ability to read, analyze and interpret financial reports, contracts, and other legal documents.
• Outstanding ability to work independently to achieve results. Must originate, plan, adapt and invent to accomplish tasks.
• Ability to set and maintain priorities when dealing with multiple demands and interruptions.
• Strong analytical and problem-solving skills.
• Dedication to the development of others and willingness to coach and mentor people as necessary to promote their personal and professional growth.
• Excellent customer service skills.
• Proven experience in revenue cycle management or in a similar role.
• Proficiency in accounting software and MS Office (especially Excel).
• Ability to travel as needed (5%).
• Exercise integrity and confidentiality in financial reporting. Comply with GAAP and HIPAA guidelines.