Director Of Revenue Cycle

POSITION SUMMARY:

Reporting directly to the Chief Financial Officer (CFO), the Director of Revenue Cycle is responsible for overseeing the development, organization, and management of the full revenue cycle, including Business Office, Coding, Registration, Prior Authorization, and Health Information Management (HIM) services. This comprehensive role is essential for maintaining the hospital's financial health and ensuring that all revenue-related processes, including patient access, run smoothly and efficiently. Manages all levels of leadership within the revenue cycle. Demonstrates behaviors outlined in BMH’s Core Values and supports BMH’s Mission and Vision.  

RESPONSIBILITIES:

• Contributes to the achievement of excellence in health care by successfully developing and implementing both strategic and operational department goals for his/her department, including but not limited to Operational Improvement, Recruitment & Retention, Staffing, Budget, Quality & Performance Improvement, Team Building & Effective Communication.

Operational Improvement

• Identifies and clearly communicates departmental vision which demonstrates a high commitment to improving patient experience and the work environment.
• Develop and implement strategies to minimize bad debt, enhance revenue capture, and improve cash flow.
• Collaborate with various stakeholders to align revenue cycle activities with the hospital’s strategic goals.
• Monitor and analyze financial data to make informed decisions regarding staffing and budget.
• Establish annual financial goals and use benchmarking to set targets.
• Create business plans and justify variances while analyzing the cost-benefit of programs.
• Ensure compliance with federal and state regulations.
• Successfully develops, communicates, and achieves departmental goals and objectives.
• Implement process improvements to optimize the revenue cycle.
• Track metrics and report trends, making recommendations for areas of improvement.
• Oversee the business office functions, including patient billing, collections, and customer service.
• Ensure accurate and timely processing of claims and payments.
• Develop policies and procedures to improve business office efficiency and effectiveness.
• Prepare and present regular reports on revenue cycle performance to senior management.
• Utilize data analytics to identify trends, forecast revenue, and make strategic recommendations.
• Ensure transparency and accuracy in financial reporting and compliance with regulatory requirements.
• Oversee patient access services, including scheduling, registration, and insurance verification.
• Ensure a smooth and efficient patient intake process to enhance patient satisfaction.
• Develop and implement policies to improve patient access operations and reduce wait times.
• Measures performance against KPIs and industry benchmark data in the revenue cycle to ensure the organization is maximizing revenue.
• Manage a diverse team, ensuring quality documentation and clinical consistency.
• Guide department leaders for effective resource allocation based on patient volume and budget constraints.
• Cooperates with other departments to support and enhance patient flow and works well with the Leadership Team for a unified approach to management.
• Designs and implements planning processes at departmental level which integrates into the Hospital’s strategic plan.
• Contributes to the effective management of the department through the consistent application of Hospital policies and procedures.
• Participates actively in Hospital councils, committees and task forces.
• Demonstrates staff and physician satisfaction improvement through measurable venues.
• Demonstrates staff participation in improvement initiatives.
• Uses unit data to creatively improve patient care as evidenced through PI plans and reports.
• Uses creativity and professional interdependence in decision making.
• Remains visible to staff and offers assistance when needed.

Recruitment and Retention

• With input from staff, develop an annual department-specific recruitment and retention plan to enhance communication and interpersonal relationships, improve productivity and departmental systems to improve morale and reduce turnover.
• o Assists staff in developing goals and objectives for individual growth and development to meet current and future department needs.
• o Provides orientation and in-service training for department staff to promote professional growth.
• o Creates a positive work environment which promotes bilateral communication and recognizes/rewards excellence.
• o Proactively and timely addresses conflict through use of the Hospital’s conflict resolution program.
• o Provides ongoing constructive feedback regarding performance/behavior, including timely completion of probationary and annual performance reviews and timely resolution and management of performance issues. Responsible for completion of 95% of department performance evaluations by annual evaluation due date.
• o Supports collaborative, patient-centered interdepartmental relationships.
• o Maintains positive interpersonal relationship with staff.
• o Supports professional growth of staff and self.

Staffing

• Supervises staff to ensure a high level of productivity and quality of work.
• Interviews and recommends for hire competent staff according to Human Resource policies and employment laws.
• Determines the staffing needs, work methods and performance standards to ensure appropriate coverage to meet operational needs.
• Verifies annually Licensure/Certification for staff where required.
• Reduces sick calls, tardiness and instills a committed work ethic to staff.
• Promotes teamwork among unit staff and staff in other departments.

Budgetary

• Achieves budgetary and financial goals through establishing and effectively managing variable departmental budget within 2% of budget, according to utilization assumptions.
• Ensures effective utilization of staff to maximize productivity while maintaining quality operations.
• Plans effectively the use of the department’s staff resources, supplies, capital equipment and other non-labor expenses.
• Eliminates/minimizes the use of temporary agency nursing staff.
• Eliminates/minimizes the use of staff overtime, bonus or mandatory overtime.

Quality/Performance Improvement

• Identifies and implements quality improvement programs to enhance services and improve both efficiency and effectiveness of operations.
• Supports the Quality Improvement initiatives by providing coverage for team members to attend meetings and complete assignments, as appropriate.
• At a department level, reviews and approves, as appropriate, performance improvement changes and ensures ongoing monitoring and evaluation to meet stated objectives and improve patient experience.
• Promotes a customer-oriented staff by encouraging the staff to be responsive to customer needs.
• Participates in interdisciplinary and department projects to improve patient care and the hospital environment.
• Demonstrates department audits show compliance with all Regulatory Agency and quality standards at required compliance levels (%).

Team Building and Effective Communications

• Clarifies roles, responsibilities and expectations within the team
• Encourages team members to share best ideas and practices in order to help one another
• Recognizes and rewards both individual and team achievements
• Fosters an environment of teamwork and collaboration through mutual respect and effective communication
• Listens and effectively interacts with others without alienation of others
• Demonstrates an effective communication style with all levels of personnel
• Actively builds upon the feedback of others
• Demonstrates the ability to manage the patient accounting system and to insure acceptable accounts receivable levels are maintained, as determined by industry standards and annual hospital objectives.
• Collaborates with Chief Financial Officer to plan financial goals consistent with organizational mission and fiscal strategies.
• Evaluates and monitors effectiveness of methods to insure timely receipt of payment on self-pay accounts.
• Maintains appropriate controls over cashiering function and coordinates with general accounting to insure proper cash balancing and reconciliation procedures are maintained.
• Prepares and analyzes month end reports to track trends in receivables and prioritize follow up activity.
• Participates in Finance Committee meetings to clarify AR issues and status.
• Strives to improve the automation of routine billing and collection functions by maintaining and implementing current edit programs and maximizing system resources.
• Monitors daily productivity reports to insure timeliness of all billing activity.
• Tracks AR reports, cash posting activity, exception reports, etc. and works with other departments, such as Med Info to expedite release of accounts for billing.
• Assists staff by personally handling complex problem accounts to facilitate resolution.
• Involves staff in setting goals for reduction/improvement in AR levels.
• Responsible for compliance with all state and federal requirements related to submission claims including interpretations, implementation, testing and training.
• Approves all bad debt and free care transactions in accordance with established budgets.
• Provides quality driven customer service systems to ensure patients’ rights are maintained.
• Encourages “the patient is always right” philosophy so all patients will have a positive first impression.
• Motivates staff to handle difficult situations with tact and diplomacy.
• Assists staff to prioritize activities for patient convenience and satisfaction.
• Coordinates and researches complaint issues with the patient advocate; responds directly to problems in writing.
• Collaborates with other departments to facilitate the exchange and improve the accuracy of patient information from the registration process through account finalization.
• Appropriately monitors the AR/ADT system’s effectiveness, implementing system upgrades and maintaining programs and functions.
• Documents and reports to vendors any problems with functionality. Follows up to ensure corrections are made.
• Ensures all third-party changes are implemented on a timely basis by working with vendors and intermediaries to meet required timelines.
• Responsible for all system generation of all bills, forms and reports.
• Responsible for maintenance of all host system AR/ADT master files; insures all related and affected functions are in sync, updates are current and operational.
• Ensures that PC based software and hardware problems are resolved quickly to minimize downtime.
• Works with other departments on interface implementations and maintenance to ensure all information is accurate and complete.
• Participates in, or is directly responsible for, decisions related to selection of new systems for the business office.
• Continually seeks opportunities for improvement in system functionality.
• In a manner consistent with the hospital’s mission, vision and strategy, provides managerial direction and supervision to all Business Office departments to insure effective operation.
• Reviews all requests for supplies and equipment, monitors budget compliance.
• Plans alternative methods of covering routine duties by recruiting volunteers or utilizing off shift personnel.
• Encourages TQM methods by empowering staff members to assume responsibility for decision making and problem solving.
• Ensures all departments conduct regular staff meetings.
• Standardizes existing procedures for more efficient daily operations.
• Exhibits a good understanding of the Vermont regulatory and reimbursement environment by recognizing the importance of employing effective networking methods and establishing ongoing relationships with intermediaries and other providers.
• Regularly attends healthcare financial management meetings.
• Maintains an active role in the Vermont Patient Account Managers Group.
• Utilizes effective negotiating skills in dealings with intermediaries relative to contractual or claims processing issues.
• Demonstrates ability to monitor and/or select appropriate external vendors to best meet hospital needs.
• Monitors collection agency productivity, meets regularly with representatives to discuss plans for enhancement of existing services or resolution of problems.
• Works with hospital attorney(s) on special projects and delinquent accounts.
• Evaluates outside agencies for special projects or contracts related to self pay receivables or special projects.
• Demonstrates ability, willingness and flexibility to assume other duties as necessary and appropriate.
• Assists the Controller on all audits by retrieving information, clarifying detail and preparing confirmation material on a timely basis.
• Assists the CFO on special projects as assigned.
• Monitors the telecommunications budget, services and invoices and works with vendors in an ongoing effort to reduce costs.
• Prepares and updates all job descriptions and standards for Patient Financial Services.
• Performs other duties as assigned.   

REQUIRED SKILLS:

1. Possesses strong leadership skills with the ability to effectively manage multiple areas and work with various disciplines and staff levels.
2. Have demonstrated exemplary customer service by responding to complaints promptly. 
3. Demonstrated experience in providing excellent customer service, conflict mitigation, and resolution.
4. Demonstrated leadership skills through the ability to lead and mentor a team.
5. Advanced knowledge of front, middle and backend revenue cycle.
6. Have substantive knowledge of medical terminology and insurance as it relates to the full revenue cycle functions.  
7. Demonstrated knowledge and use of applicable software applications.
8. Possess clear and concise written, verbal, and presentation skills. 
9. Display strategic thinking skills, strong analytical skills, and problem-solving abilities.
10. Ability to work collaboratively to resolve denials.

EDUCATION:

• Bachelor’s degree in Business Administration, Healthcare Management, or another related field, or any equivalent combination of education, experience, and training that provides the required knowledge, skills, and abilities. Advanced degree preferred.

EXPERIENCE:

• Minimum five years’ experience at the management level in the revenue cycle. 
• Knowledge of healthcare regulations and compliance standards for the revenue cycle.
• Prior experience managing staff, establishing goals and process improvement.
• Sound understanding of systems, procedures and general Revenue Cycle function.
• Ability to prepare, interpret and communicate statistical reports to colleague and management providing guidance and input for improvement.
• Strong Commitment to maintaining BMH Core Values

LICENSE/CERTIFICATION:

Certified Healthcare Financial Professional (CHFP), 

Certified Revenue Cycle Representative (CRCR), or 

HFMA Fellow (FHFMA) desired.