Director of Revenue Cycle - Houston, TX
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- Manages the department within the established budget.
- Manages the precertification process between the physician practice and the hospital/ASC and tracks statistical information monthly.
- Manages the coding process implemented to assure the most accurate and cost effective coding of all claims.
- Manages the filing and resolution of claims with individual carriers or agencies. Insures maximum reimbursement through strategic financial planning.
- Monitors changes in the medical insurance industry and adjusts procedures accordingly. Aggressively pursues cost reimbursement through settlement negotiations.
- Reviews and evaluates health insurance claim policies and procedures for insurance plans, develops new procedures to improve the quality and quantity of work processed.
- Monitors and evaluates monthly insurance reimbursements compliance and budgets.
- Manages updating of contract matrix with accurate terms and fee schedules and establishes a common reimbursement grid by procedure code.
- Manages the collection of accounts, the maintenance of the Medicare bad debt and the outsourcing of account receivables following appropriate protocols.
- Solves difficult insurance claim problems.
- Supervises, trains, and mentors assigned personnel. Evaluates performance and recommends merit increases, promotions and disciplinary actions.
- Initiates and answers pertinent correspondence. Prepares and writes reports. Maintains required records and files.
- Maintains knowledge of and complies with established policies and procedures.
- Bachelor’s degree in business or equivalent. Master’s degree preferred.
- Minimum five years supervisory experience in a health care setting.