Director of Revenue Cycle Management

Description

The Director of Revenue Cycle Management is responsible for the management and supervision of all functions related to utilization management, billing, and collections in the organization. The Director of Revenue Cycle Management will be responsible for developing policies, processes, and procedures with the support of the CFO that maximize revenues and minimizing the length of the revenue cycle to support the cash cycle requirements of operating the organization. The Director of Revenue Cycle Management will create and review periodic reports, analyze outcomes, identify trends, and ensure timely and proactive communication to leadership. The Director of Revenue Cycle Management will participate in month-end closing procedures to reconcile accounts receivable ledgers, write-off uncollectible balances, and make other accruals and adjustments as necessary. Supervises billing, utilization management, and accounts receivable staff.

Requirements

Duties/Responsibilities

• Implement and maintain best practices for all Revenue Cycle activities for all locations. Work closely with all departments within the Revenue Cycle to ensure processes are best practice; develop metrics based on best practice and measure improvement against metrics.

• Identify, collect and report relevant statistical data to CFO consistently and timely.

• Working with CFO to develop KPI’s to be included in financial reporting dashboards to ensure the organization meets benchmarks.

• Work closely with EMR administrator and Systems Admin to develop and maintain billing and reporting processes.

• Establishes policies and procedures for eligibility and benefit verifications, and time of service collection requirements.

• Conducts internal audits. Review and evaluate results. Make recommendations based on these results to improve revenue, workflows and/or compliance regulations.

• Working with CFO to implement training & education programs and provide feedback as needed for medical and clinical providers and staff related to billable services.

• Maintain Chargemaster for all contracted and FFS rates.

• Implement/Maintain EFT and ERA enrollment for all payers.

• Attends trainings and participates in manager meetings.

• Lead and Direct UR Manager in leading the UR team.

• Monitor UR team to ensure all reviews are completed in a timely matter.

• Report any changes in payer process for authorization.

• Coordinate Treatment Teams for all facilities to assure accuracy on patients’ cases.

• Provide Trends of Denials, Peer to Peers, regulations of payers that will affect reimbursement.

• Establish work relationships with provider reps from all insurance companies.

• Establish training system for UR new hires, PRN, coverage.

• Work along side UR Manager and treatment team to ensure proper utilization services.

• Monitor health plan response files to ensure appropriate action is occurring including timely posting of files to the system.

• Ensures accurate reimbursement is being received for services rendered.

• Works collaboratively with leadership on key performance indicators (KPI’s) and effectiveness of the billing team.

• Manage Medical Record Request Supervises and monitors the release of confidential information in accordance with rules and regulations.

• Responsible of coding regulations and policies for accurate billing

• Responsible for the oversight of integrity, security, and privacy of all financial and clinical data

• Active knowledge of Medicaid and CMS guidelines, contracted insurance guidelines and coding policies.

• Performs other duties as assigned.

Supervisory Responsibilities

• Accomplishes billing human resource objectives by selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining employees; communicating job expectations; planning, monitoring, appraising job contributions; recommending compensation actions; adhering to policies and procedures.

Education and Experience

• College grad

• At least 5 years of Revenue Cycle experience in a supervisory capacity.

• At least 2 years of AHCCCS experience with a healthcare organization.

Required Skills/Abilities:

• Excellent verbal and written communication skills.

• Excellent interpersonal and customer service skills.

• Excellent sales and customer service skills.

• Excellent organizational skills and attention to detail.

• Excellent time management skills with a proven ability to meet deadlines.

• Strong analytical and problem-solving skills.

• Ability to prioritize tasks and to delegate them when appropriate.

• Ability to function well in a high-paced and at times stressful environment.

• Proficient with Microsoft Office Suite or related software

Competencies

• Technical Knowledge – Knowledge of or ability to learn QuickBooks Online, SharePoint, OneDrive, Kipu, Collaborate MD, various payor portals.