Director of Revenue Cycle

DIMENSIONS/SCOPE OF POSITION:

 The Director of Revenue Cycle Management reports to the CFO and is responsible for overseeing and coordinating all revenue cycle activities with a goal of maximizing reimbursement in a cost-effective manner that is in compliance with federal, state and payer-specific billing requirements. The Director will oversee the overall policies, objectives, and initiatives of our healthcare facilities’ revenue cycle activities to optimize the patient financial interaction along the care continuum.

ESSENTIAL DUTIES/RESPONSIBILITIES:

 Oversee and support the daily operations of all patient financial services (PFS) functions, including billing, follow-up and collections, cash posting and all Patient Access areas.

• Work closely with other departments (HIM, Case Management, Information Technology, Clinics, etc.) to streamline procedures that will help ensure correct billing to patients and payers in a timely manner, thereby expediting Clinic receivables.
• Oversee the work schedule and direct changes in priorities and schedules as needed to ensure work is completed in an efficient and timely manner and to improve the department’s performance and service.
• Implement a Quality Assurance program for PFS functions and monitor staff and team performance, making changes, when required, to support accurate billing to payers and patients in a timely manner and compliance with laws and department procedures.
• Assist with the development of budgets and monitoring of department operations to achieve goals within the budget.
• Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Maintain appropriate internal controls for the safeguarding of cash.
• Follow and monitor compliance with Clinic 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.
• Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.
• Serves as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implementing solutions.
• Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks.
• Responsible for maximizing the collection of medical services payments and reimbursements from patients, insurance carriers, financial aid, and guarantors.
• 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.
• Monitors daily productions of claims, denials, and appeals.
• Analyzes claims, utilization, and medical cost data.
• Monitors aged accounts and verify appropriate collections procedures are being followed.
• Reviews, monitors and recommends updates to the Clinic’s fee schedule to maintain fees at levels that maximize reimbursement.
• Ensures compliance with relevant federal, state, and payor-specific billing requirements.
• Regularly provides upper management with revenue cycle status including reports, metrics, and presentation.
• Establish a regularly scheduled revenue cycle meeting to discuss strategies and ensure everyone is educated on 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.
• Any and all other projects, goals, issues surrounding the revenue cycle, conflicts or concerns as directed or indicated by Administration.

SUPERVISORY RESPONSIBILITIES:         Central Business Office