Endevis talent acquisition firm is partnering with a local Company to find a Director of Revenue Cycle Management. The Director of Revenue Cycle Management is accountable and responsible for the overall leadership of revenue cycle services of the faculty practice group in both provider-based and physician office settings.
This role requires current, in-depth knowledge of governmental and commercial insurance rules and regulations, including regulatory compliance requirements applicable to a physician group revenue cycle that has both provider-based and physician office site of service components. The Director of RCM is accountable for ensuring the coordination of revenue cycle operations, procedures, and best practices for provider insurance credentialing, charge capture, billing, payment posting, collections and follow up, denials management, billing audits, and revenue cycle data reporting throughout the organization.
Daily Activities & Continuous Improvement:
- Evaluating the effectiveness of centralized revenue cycle services, including charge capture, billing, collections, data reporting, and implementing changes to policies, procedures and systems, as appropriate.
- Providing the analysis, reporting, recommendations and implementing strategic action plans for revenue cycle services performance in key metrics related to charge capture, billing, collections and accounts receivable management, such as volumes, collection ratios, A/R aging, charge lag, and related trends to the CFO and practice management staff.
- Setting budgetary guidelines and making spending and resource decisions within those guidelines, ensuring accountability to operating and capital budget.
- Creating a department wide understanding of the regulatory issues affecting Revenue Cycle, provider documentation and coding and maintaining compliant policies and procedures.
- Assesses and responds to current and future internal and external healthcare trends to establish and ensure the necessary direction for revenue cycle activities.
- Continually seeks ways and means for improving the delivery and support of revenue cycle activities and programs including monitoring the routine development of training material and ensuring educational resources to current and future staff.
- Assures satisfaction among administration and providers with the quality and amount of support and data provided by monitoring and responding appropriately to outcomes and feedback while fostering a positive patient experience.
- Understands the job functions of all Revenue Cycle staff, is aware of process flow across departments, and involves them, as appropriate, when recommended actions may impact their work functions.
- Demonstrates good judgment in making decisions (timing, involvement of others, information presented, impact on others and operations) and is resolute in making a decision to act.
- Leads efforts in monitoring and researching of regulatory changes and proposes actions to respond to changing legislation/regulations.
- Directs the maintenance of the practice management system master files for ensuring that the system is capable of efficiently managing the billing process.
- Monitors the payments of third-party payers for assessing compliance with established contracts.
- Develops policies and procedures for all point of the revenue cycle including, but not limited to, charge capture, data entry, payment posting, insurance follow up, collections and denials management.
- Reviews and updates the charge master, adjustment and denial codes as necessary. Identifies trends and accordingly makes appropriate recommendations.
- Holds regular meetings with departmental supervisors and keeps them abreast of important issues related to revenue cycle operations.
- Develops and maintains relationships with major payers.
- Collaborates with clinical, financial, and managed care teams to support pay-for-performance and value-based care incentive programs.
- Acts as a liaison for dealing with departmental supervisors and hospital staff.
- Develops and implements evaluation tools and measures staff efficiency and effectiveness.
- Researches department, payer, provider and other specific issues associated with revenue cycle performance.
- Provides ongoing comparisons of standard professional billing to rural health benefits, provider-based billing, federally qualified health clinic status and/or other reimbursement methods with a purpose of analyzing ongoing cost / benefit of these methods to help the organization select the optimal billing methodology.
- Works with staff from Information Systems to ensure system integrity.
- Works collaboratively with the Central Verification Office (CVO) to ensure that physician enrollment is timely and complete. Continually seeks out opportunities to improve, including automated solutions.
- Discusses performance data with senior management, Chairs, Department Supervisors, and others as necessary.
- Keeps abreast of industry regulations, standards, trends and technologies.
- Acts as a resource to assist departments in revenue cycle performance.
- Troubleshoots problems associated with missed or unbilled charges, payment delays, denials, and other revenue cycle issues.
- Other duties assigned.
Knowledge, Skills and Abilities:
- A bachelor’s degree in business, health care administration or related field is required; Masters preferred in a related field.
- Excellent communication and collaboration skills across a range of stakeholders.
- Minimum 10 years of revenue cycle experience with progressive responsibility managing physician group revenue cycle functions.
- Experience with practice management systems such as Athena, Epic, etc.
- Knowledge of Managed Care, Third Party Payer, and Medicare Regulations.
- Prior experience leading various areas of revenue cycle (charge capture, coding, billing, collections, denials, etc.) with proven success in achieving revenue cycle efficiencies and improving cash flow.
- Experience with data analysis in the healthcare industry.
- Experience working closely and communicating directly with physicians, and executives.
- Must have the ability to handle multiple tasks and work with various tight deadlines.
- Strong communication skills.
- Demonstrated interpersonal skills to work with physicians, patients, and staff at all levels, must have the ability to relate to people in a manner to win confidence and establish rapport.
Endevis, LLC. and all companies represented are Equal Opportunity Employers and do not discriminate against any employee or applicant for employment because of age, race, color, sex, religion, national origin, sexual orientation, gender identity and/or expression, status as a veteran, and basis of disability or any other federal, state or local protected class.