Revenue Cycle Director will oversee Physician Billing, Home Health, and Hospice billing. Manage the Accounts Receivable activities and denials process. Also, identifies and implements information system solutions that support more efficient work performance.
- Provides operational management and leadership for Medicare, Medicaid, Private Pay, and third party billing, and collection activities for the Continuum of Care.
- Implements business/ operational plans to accomplish cash collection goals and minimize bad debt expense.
- Ensures departmental policies/procedures are in compliance with all laws/ regulations.
- Designs and monitors key performance indicators to report risk areas to leadership and monitors effectiveness of staff.
- Provides direction to management regarding payer contractual terms and/or state and federal reimbursement regulations affecting the department's processes.
- Monitors billing systems to ensure timely/accurate billing and collection practices within established time frames. Develops procedures/plans to ensure staff handles all patient accounts according to procedures and ensures productivity targets are achieved.
- Develops and monitors the quality review processes for each function within the department and provides summary reports to the AVP of Revenue Cycle.
- Monitors and maintains third party vendor relationships to ensure they are in compliance with Company policy, and state/federal regulations. Provides targets and goals to measure outsource vendors.
- Maintains knowledge of all insurance, government, HIPAA, health care reimbursement, general billing practices and state regulations/laws to ensure the company is following the appropriate guidelines/regulation and remains in compliance with these.
- Responsible for oversight of Medicare Credit Balance reporting, Nursing Home Room and Board reporting, Administrative Adjustment reporting, Month End Close process, and participates in internal and external audits. Acts as the liaison with state and federal fiscal intermediaries, as needed or requested.
- Reviews and monitors aged accounts receivables and develops and implements processes to reduce days in accounts receivable.
- Prepares and manages departmental budget and provides monthly update on variances, when applicable.
Revenue Cycle Systems Administration
- Responsible for system assessment, process analysis, identification of system requirements and functional definition of planned system changes in cooperation with Administrative/Management and key business owners.
- Assesses plans, develops, implements and maintains assigned Revenue Cycle information systems needed to support the Company-wide business operations.
- Responsible for identifying and implementing Revenue Cycle system solutions that support more efficient and effective work performance based on knowledge of business functions and processes.
- Shares responsibility for data integrity and maintaining security on all assigned systems.
- Participates in the development and delivery of IT Revenue Cycle projects.
- Serves as the Revenue Cycle Systems Administrator and as an educator and resource regarding system functionality.
- Prepares complete test plans and test methodologies, coordinates unit, system and acceptance testing, documents test results to verify outcomes and client acceptance/signoff for changes.
- Participates in the development of Revenue Cycle systems' standards, policies and procedures.
- Responsible for end-user testing in system patches, releases, and other maintenance required activities so that Revenue Cycle systems are current, maintained and supported.
- Performs post implementation support of newly installed/modified systems for a period of time to be determined on a case-by-case basis.
- Ensures daily ERA/cash balancing and posting of billable community physician charges to hospice Part A claims.
- Serves as an internal consultant for systems supported.
- Effectively uses office automation tools for purposes of creating documentation, presentations, productivity tracking, and/or creating customer deliverables.
- Educates others on appropriate utilization of Revenue Cycle systems to support the delivery of quality of care and operational/research excellence.
- Supports system functionalities and training; promotes rigor and efficiency during the monthly Patient Accounting close process.
- Responsible for problem identification, root cause analysis, and resolution for assigned systems.
- Responsible for personnel management, performance reviews, competency development, and coaching of staff.
- Builds strong relationships with business and clinical users groups across the Organization including managers and directors.
- Ensures that the design and use of Revenue Cycle applications adhere to established policies, procedures, and standards.
- Leads analysis of organizational needs for development and implementation of Revenue Cycle systems: interfaces with users to ensure that applications are developed which meet their business specifications.
- Works with subject matter experts and services resources in managing resolution of application incidents and requests.
- Creates an open environment and encourages information sharing, team-based resolutions, cross-training, and process improvement within the area and across organizational boundaries.
- Coordinates the sharing of best practice models, and policies & procedures related to Revenue Cycle systems. Participates in activities to improve departmental and organizational performance.
- Establishes and maintains relationships with outside vendors of Revenue Cycle products, professional organizations, care partners, external auditors, and consultants.
- Bachelor's degree with emphasis in healthcare administration or business, but may be substituted by substantial relevant work experience
- Minimum of seven (7) years' management in healthcare revenue cycle and systems technical experience
- Knowledge of clinical and billing application interfacing
- Experience in System Administrator functions as related to revenue cycle
- Knowledge in claims processing and Third Party Administrator claims processing
- Demonstrated expertise and knowledge with third party payors to include Medicaid, Medicare and their state and federal regulations for both Acute and Professional billing and collections rules and regulations
- Proven successful experience leading, coaching, and mentoring management and subordinates
- PC proficient (Word, Excel, Access, PowerPoint, Outlook, Project, Visio, etc.) and multi-system applications