We are hiring a Director of Revenue Cycle Management who will provide leadership in Revenue Cycle Management across all business units. Directs Billing team, assists in contract negotiation and maintenance, manages outside vendors, partners with Accounting & Finance, performs Claims Analysis, and makes recommendations on maximizing Revenue, all with a focus on process, communication and team effort.
- Leads the identification of opportunities to optimize revenue collection through proper coding, encounter/claims submission, and payment reconciliation across the enterprise
- Manages existing contracts and provides assistance in negotiations to maintain and secure financial agreements with payor sources.
- Leads business process improvement efforts in collaboration with clinical, operational, growth and IT counterparts to develop automated, repeatable processes and systems to optimize revenue collection.
- Independently identifies and pursues revenue improvement opportunities through process improvement and data management.
- Develops and presents ROI-based recommendations to executive leadership, regarding process changes, revenue capture opportunities, staffing changes, or training opportunities that accelerate or maximize revenue collection.
- Performs claims analysis, generates, and presents reporting around KPIs and collaborates with operations and revenue cycle team members to evaluate and resubmit claims submissions as necessary.
- Tracks numerous metrics related to the patient engagement cycle including record coding error rates and billing turnaround times to develop sound revenue cycle analysis and reporting.
- Participates in the development of coding and billing strategies, evaluating process relative to Revenue Cycle and making recommendations while ensuring compliance with any relevant rules or regulations (including HIPAA, Medicaid, Medicare, and specific 3rd Party Payors).
- Collaborate with IT and other teams relative to contracting and clinical considerations that impact claims submissions and other reimbursement models and implementing changes and upgrades.
- Manages relations with payers and providers to generate high reimbursement rates and a low level of denials. Partners with Accounting/Finance on reporting monthly revenue numbers, analyzing revenue drivers, and collections of Accounts Receivables.
- Maintains professional relationships and collaborates across teams, managing projects, facilitating meetings and presenting in various settings, including to executive leadership.
- Bachelor’s Degree in Healthcare, Business, or related field
- 8 years healthcare experience Medical and/or Behavioral Coding, Billing, Claims, or similar RCM function
- 5 years of management experience in Revenue Cycle
- Proficient in relevant billing terminology (CPT codes, Modifiers, ICD-10, etc.)
- Working knowledge of 3rd party billing requirements, reimbursement principles, compliance regulations, standards and directives regarding governmental/regulatory agencies and payor contracts.
- 10+ years healthcare experience Medical and/or Behavioral Coding, Billing, Claims, or similar RCM functions
- 5+ years of management experience in Revenue Cycle
- Strong knowledge of 3rd party billing requirements, reimbursement principles, compliance regulations, standards and directives regarding governmental/regulatory agencies and payor contracts.
- Prior experience across multiple Payor types (Medicaid, Medicare, Commercial, etc.)
- Sage Intacct
- Bachelor’s degree in Healthcare, Business, or related field