Description

SUMMARY OF RESPONSIBILITIES

The Director of Revenue Cycle Management is responsible for all activity for the revenue cycle within Pain Treatment Centers of America (PTCOA) clinics and ambulatory surgery centers. This position oversees the processes and provides direction, guidance, and support to the billing and insurance teams.

Requirements

ESSENTIAL FUNCTIONS

(1) The Director of Revenue Cycle Management is responsible for the coordination of the Revenue Cycle Department, which includes billing and collection activities.

(2) Responsible for overseeing eligibility, pre-authorization, time of service collections of co-pays and deductibles, coding of services, and reporting.

(3) Reviews, revises, and/or implements policies and procedures within the department to ensure that best practices are followed in both the billing and collections functions, while remaining in compliance with federal/state laws, rules, and regulations as well as third party contracts.

(4) Oversight of charge entry, claim submission, payment posting, denials management, bad debt and collections, appeals processing, credit balance resolution, and accounts receivable management. This includes being responsible for monitoring the productivity of all staff members- in person and those who work remotely.

(5) Generates billing and collections data that supports finance and business operations and produces pricing and coding feedback that will optimize reimbursement. 

(6) Provides strategic guidance and analysis of the revenue cycle service line.

(7) Reviews, designs, and implements processes surrounding third party payer relationships, collections, and other financial analyses to ensure clinical revenue cycle is effective and properly utilized.

(8) Ensures all billing and collection practices are appropriate and align with payer policies and guidelines.

(9) Identifies payer trends and reimbursement issues that can negatively impact the revenue cycle.

(10) Utilizes data analysis, report writing and electronic data retrieval skills to extract, compile and present clear and concise information.

(11) Maintains an understanding of coding rules and guidelines; utilizes coding and claims processing knowledge and resources to identify possible risks and revenue opportunities related to coding.

(12) Collaborates with the Company’s external CPAs and Chief Legal Officer to ensure compliance with regulatory requirements.

(13) Identify and correct workflow issues to help optimize revenue.

(14) Works with Director of Practice Management and ASC Administrator regarding any front desk or clinical workflow issues that may impede revenue cycle.

(15) Works with collection vendors on accounts that are deemed delinquent.

(16) Monitors A/R to include oversight of days in A/R, gross billings, gross collections, net revenue, percent of collections to net revenue, monitoring and management of denial rates and denial categories related to activity.

(17) Develop metrics and benchmarks for billing and accounts receivable.

(18) Oversees and directs the creation and continual improvement of departmental procedures and best practice tools for billing, reimbursement, and collections.

(19) Responsible for departmental specific training of employees; planning, assigning, and directing work; appraising performance; disciplining employees; addressing complaints and resolving problems.

(20) Adheres to professional standards, company policies and procedures, and federal, state, and local laws and regulations.

(21) Works to reduce charge holding, rejections, missing information, and denials reports.

(22) Prepares billing reports summarizing billings, adjustments, and revenues received. Performs other related duties as assigned by CEO, COO, and Owner.

CORE COMPETENCIES

· Excellent oral, written, interpersonal, communication and presentation skills.

· Ability to communicate effectively in a variety of settings and with a wide variety of people and different organization levels.

· Ability to effectively supervise employees.

· Highly organized with the desire and ability to effectively track projects from start to finish.

· Must be able to manage multiple projects simultaneously.

· Ability to work in a team environment as well as independently and with little to no supervision.

· Demonstrate consistent reliability, integrity, and dependability.

· Setting and achieving high goals and standards of performance.

· Ability to meet strict deadlines and keep others on the schedule.

REQUIRED  EDUCATION, EXPERIENCE, AND/OR CERTIFICATIONS

The position requires a bachelor’s degree in a related field, plus 5 years of relevant experience within the healthcare industry. The ideal candidate will have at least 2 years of progressive and related experience in physician billing or practice management and/or at least 2 years of management experience in revenue cycle management.

WORKING ENVIRONMENT AND PHYSICAL DEMANDS

This is a full-time position. Days and hours of work are expected to include 8:00 a.m. to 5:00 p.m. (Monday through Thursday) and 8:00 a.m. to 12:00 p.m. (Friday). Occasional overtime may be required. This position requires frequent travel and operates in a professional office environment when not traveling. The incumbent, in the course of performing this position, spends time writing, typing, speaking, listening, driving, seeing (such as close, color and peripheral vision, depth perception and adjusted focus), standing, sitting, walking, and reaching. The incumbent operates all standard office equipment, motor vehicles, and mobile phones. The work environment characteristics and physical demands described here are representative of those an employee encounters while performing the essential functions of this job.

OTHER

The Revenue Cycle Director’s performance is evaluated by the Chief Operating Officer/ Executive Vice President and the Chief Financial Officer[HM1] . AAIT Health reserves the right to change this job description at any time according to business needs and/or assign tasks that it may deem appropriate. This document does not represent a contract of employment, and employment with AAIT Health may be terminated by the employee or employer at any time, for any reason.