Revenue Cycle Director

Position Summary:

The Director of Revenue Cycle Management (RCM) provides strategic leadership and operational oversight for all aspects of the end-to-end revenue cycle, including Patient Access, Insurance Verification, Charge Capture, Medical Coding, Claims Submission, Denial Management, Payment Posting, Collections, and Patient Financial Services. This position ensures that all billing, reimbursement, and payment processing activities are completed accurately, timely, and in full compliance with federal and state regulations, payer requirements, and organizational policies.

The Director of Revenue cyle Management is accountable for maximizing net revenue, , improving the cost-to-collect, minimizing bad debt, reducing denial rates, and optimizing accounts receivable performance across all ambulatory clinic locations.

Essential Responsibilities:

· Manage payor relations and providers to generate high reimbursement rates and lower denial levels.

· Develops integrated revenue/expense analyses, projections, reports and presentations.

· Conduct ongoing trend analysis on third-party payor payment levels to ensure reimbursement in accordance with allowable amounts outlined in agreements and contracts.

· Coordinate with other department leaders to ensure proper billing practices (coding, pricing, adjustments, client communications, etc.) impacting collections.

· Prepares and presents monthly, quarterly, and annual RCM performance reports for leadership.

· Identify rejects, denial and missed opportunities and resolve discrepancies.

· Maintain internal controls, policies and procedures consistent with state and federal law, compliance plans and HIPAA.

· Collaborate with the C-Suite to facilitate contract negotiations and renegotiation's of payor contracts.

· Communicates with third-party payers, operations, and other internal and external departments regarding maximization of revenue and charge optimization.

· Collaborates with operations and revenue management for the analysis and support of daily, weekly, and monthly reports to assure proper workflow in all areas.

· Monitors current and emerging reimbursement issues, regulations, and reporting requirements.

· Facilitates in-depth understanding to both technical and non-technical audiences while fulfilling business needs

· Create process improvement initiatives that maximize the performance and integrity of revenue cycle activities.

· Recruit, develop, and manage revenue cycle staff; establish performance standards and conduct regular evaluations

· Drive process improvement initiatives and technology adoption to improve efficiency, accuracy, and performance across all revenue cycle functions.

· Manage and implement new the fee schedule and allowable schedules annually.

· Perform all other duties as reasonably assigned.

Education/Experience:

· College degree highly preferred.

· An ideal candidate will have at least 5-7 years Revenue Cycle or Business Office experience.

· Must have Management experience (Healthcare Management experience highy preferred)

· Athena experience is preferred.

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.  While performing the duties of this job, the employee is regularly required to talk or hear. The person in this position frequently communicates with associates, physicians, and patients. Must be able to exchange accurate information in these situations. Strong verbal and written communication skills required. The person in this position must be able to remain in a stationary position for 50% of the time, standing or sitting. This position requires the use of hands/fingers to handle or feel. Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine and computer printer. Repetitive motion of upper body required for extended use of computers and telephones. Ability to exercise good judgment and positively influence and lead others, including handling confrontations with poise and efficiency.

Position Type/Expected Hours of Work:

This is a full-time, hybrid position supporting an outpatient medical business office environment. Standard hours are 8:00am–5:00pm, Monday–Friday, with schedule flexibility based on operational needs. On-site presence is required on a regular basis, with remote work available in coordination with leadership.

Travel:

This position may require travel.

Work Environment:

Environmentally controlled medical environment. Fast paced environment with occasional high pressure or emergent situations.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

EEO Statement:

White-Wilson Medical Center, P.A. and affiliates are equal opportunity employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.