Director of Revenue Cycle


ABOUT THE POSITION

This position is part of the revenue team, responsible for overseeing the entry of data necessary for the collection of revenues from third party payers, as well as individual patients. This position will collect data on billing issues and develop education/training for billing staff. The Director will negotiate pricing with payors. This position has the potential to have significant time interacting with patient, payers, public on the phone, as such, excellent communication skills are required.

RESPONSIBILITIES

  • Responsible for all aspects of the revenue cycle, including, functions of billing ensuring accuracy, timeliness and confidentiality.
  • Overseeing the billing and collections functions and ensuring revenue maximization while maintaining a cost-effective operation.
  • Negotiate pricing with insurance payors.
  • Develop and implement systems to capture and enter charges; submit claims to various payers; post payments to proper accounts.
  • Develop and implement collections protocol, process, and monitor on a routine basis.
  • Implement procedures to adapt to a changing revenue environment.
  • Monitor ECW/RCM’s performance. Assists CFO with ECW issues and resolutions.
  • Review patient accounts for billing quality assurance.
  • Oversee the billing function of the revenue team and works with billers to accomplish all required tasks.
  • Ensure compliance with CMS and other applicable billing/insurance agencies.
  • Develop and implement a system to track staff productivity and address issues as needed, in conjunction with Billing Manager.
  • Responsible for directing work flow of staff and handles personnel matters, such as hiring, discipline and evaluating performance.
  • Knowledgeable of Fraud and Abuse regulations and works with all staff to ensure compliance.
  • Work with Billing Manager to maintain a program to address claim denials; providing reports to appropriate supervisory staff or provider staff.
  • Performs other duties as assigned.

QUALIFICATIONS

  • High school diploma or equivalent required.
  • Minimum of five (5) years experience in healthcare billing required.
  • Knowledge of coding standards preferred.

KNOWLEDGE, SKILLS, AND ABILITIES

  • Social and cultural sensitivity appropriate to ethnically and economically diverse patient-and employee-base
  • Communicates through appropriate channels. Use proper chain of command for patient complaints.
  • Ability to handle emergency situations calmly and effectively.
  • Must be computer literate and proficient with the organization’s billing software and electronic health record.
  • Must be able to maintain good inter-personal relationship with co-workers and other members of the health care team and the organization.
  • Provide customer service in accordance to the organization’s mission.
  • Be courteous and respectful when interacting with patients and family members.
  • Maintain patient confidentiality in accordance to organization’s policy and procedure and HIPAA requirements.