NATURE OF DUTIES :
The Director of Revenue Cycle Management serves as a supervisor of the Business Office. The position provides CIS-wide authoritative medical information as it pertains to quality assurance, reimbursements, collections, and billing. The incumbent must use the knowledge, skills, and abilities to oversee the coding and billing determinations, to provide written procedures and guidelines for physicians to follow in documenting services rendered, and to assist in the review and resolution of denials from insurance companies.
SpecificDuties: 1. The incumbent of the position reviews charts and studies data throughout CIS to assess the adequacy and accurateness of medical documentation for reimbursement and risk management issues and communicates with physicians and staff on strengths and weaknesses in this area.
2. The incumbent coordinates the Medical Practice meetings in which patient complaints and incident reports are reviewed and discussed and prepares summaries and recommendations as needed.
3. The incumbent establishes and maintains regular Quality Assurance meetings throughout CIS, with appropriate personnel rotating into the leadership, in order to facilitate communication, problem solving, quality improvement, and positive attitudes among personnel.
4. The incumbent supervises the Supervisor of the Billing & Collections Department and all the nurses in the Audit Department to ensure that all coding, billings and collections are performed in accordance with policy and procedures and in an accurate and timely manner.
5. The incumbent approves leave, evaluates employee performance, and assigns work among the staff in order to accomplish the duties assigned to each department. The incumbent instructs the staff in the handling of Medicare audits and assures accurate, complete, and standard information that is gathered in response to the audit request.
6. The incumbent supervises all billing and collection duties throughout CIS and develops written policies and procedures for coding to secure accurate and consistent coding and billing practices. Incumbent provides on-going department-level training in these areas, provides physicians with a written manual for proper Medicare indications of services rendered, and serves as an organizational resource for any questions about coding, billing, and collections. The incumbent also coordinates the generation of status reports and assists in the review and resolution of any denials.
7. The incumbent serves as an in-house training resource for all supervisors and staff and provides advice and guidance, as needed, to upper level management, the CEO, or members of the Board of Directors, on any aspect of coding, billing, and collections, as may be asked or required.
8. Performs other related duties as assigned and serves in whatever other related capacity deemed necessary for successful completion of the mission and goals of CIS and in concordance with its patient philosophy.
STANDARDS OF PERFORMANCE :
1. Keeps work area neat and organized. Reports safety issues to team leader immediately.
2. Works efficiently and manages time wisely. Assist other employees when all duties are complete.
3. Communicates any problems, difficulties or concerns regarding job duties to the team leader.
4. Performs all duties without significant error occurring with any regularity.
5. Meets all deadlines and timeframes for completion of assignments.
6. Represents CIS in a professional manner at all times. Demonstrates acceptable ability to interact with physicians, staff ("internal customers") and "external customers" (patients, family members, insurance companies, home health etc.) on a professional level at all times. Exhibits good communication skills with physicians, patients, team leaders, and co-workers at all times.
7. Exhibits whenever possible a harmonious relationship with other CIS employees in order to accomplish the duties and responsibilities of the position. While perfect harmonious relationships with all employees is sometimes not achievable, not more than an occasional complaint should be received by the team leader about the incumbent of this position.
8. The employee shall work and relate cooperatively with all other employees (internal customers) of CIS to assure optimum care for the patients of CIS and to achieve standards of care set forth by the CIS medical staff.
9. Adheres to the CIS Compliance Plan as it pertains to the above specific job duties. Uses best efforts to maintain compliance by following the CIS Corporate Compliance Plan, attending CIS compliance education, following medical documentation guidelines, and communicating concerns regarding compliance issues.
10. Performs accurate and complete documentation in the patient's medical record, when applicable. This includes documentation in both the paper record and the electronic medical record (EMR).
11. Work with the electronic medical record (EMR) staff to maintain quality and work towards future EMR development.
12. Maintains patient confidentiality according to the HIPAA standards of privacy and security.
QUALIFICATIONS FOR THE POSITION :
1. Completion of a four-year post-high school program leading to a bachelor's degree in business, finance, or related field.
2. MBA preferred but not required.
4. Ability to supervise personnel of a large medical corporation.
5. Experience with computerized data processing programs
6. Experience with financial analyses/tracking programs specific to the health care industry.
7. Experience with Medicare Billing procedures and coding is desirable.