Sr Director Revenue Cycle

Position Summary

The Senior Director of Revenue Cycle is responsible for providing strategic direction in support of critical Revenue Cycle initiatives and goals. Leads and manages complex Revenue Cycle projects, drives performance, and provides the overall direction and oversight of the functional areas (Business Office, Credentialing, HIM) that support the organization’s financial and operational goals. Develops policies, procedures, and workflows related to revenue cycle functions throughout the practice. Ensures compliance with CMS regulations, company policies, and standards for third party payers. Fosters and promotes a culture of excellence in customer service to internal and external clients. Builds trust and collaboration amongst the team by enhancing employee engagement, addressing performance results, and providing coaching and mentoring.

Essential Duties and Responsibilities include the following:

1. Uses a proactive leadership style to model and promote a culture of trust and collaboration. Where appropriate, involves staff when recommended changes or actions may impact their work functions.
2. Responsible for effective identification of staffing resources, recruitment, allocation of resources, retention, recommending salary changes, and progressive discipline.
3. Provides leadership and mentoring to individuals reporting directly to this position. Ensures performance feedback is provided and uses evaluations as management tools for coaching and development. Develops and maintains an annual professional development plan.
4. Knows the key requirements of each position and holds staff accountable for the responsibilities inherent in their roles.
5. Holds all staff members accountable for following and adhering to regulations, company policies, HIPAA laws, CMS guidelines and statutes.
6. Encourages staff to attend educational opportunities relevant to their position and supports their attendance.
7. Functions as a highly visible, approachable, and accessible leader. Acts as a catalyst to promote positive change, and stimulates others to change.
8. Creates a motivational environment. Provides challenging assignments and opportunities for development. Effectively communicates and cascades information to staff.

Customer Service/Continuous Improvement

1. Promotes a service-oriented culture within the organization and assures satisfaction with the quality and amount of support provided for departmental functions, initiatives and projects.
2. Responsible for solution planning including defining scope and planning for new solutions and applications. This includes determining how to measure results, modeling, testing, and validating current and future processes. Must also have the ability to identify the organizational changes required to successfully realize the benefits of a solution or application.
3. Assesses and responds to current and future internal and external healthcare trends in order to establish and ensure the necessary direction for revenue cycle activities. Consistently and regularly reviews payer newsletters, updates from CMS and Medicare intermediary Novitas, meetings and communications with payer representatives, and other sources and determines relevancy to the department or practice.
4. Continually seeks opportunities for improving the delivery and support of revenue cycle activities and programs.
5. Assures satisfaction among customer groups with the quality and amount of support provided by monitoring and responding appropriately to outcomes and feedback.
6. Actively engages in understanding the job functions of staff as it relates to the process flow across the departments.

Revenue Cycle Management

Oversight for Credentialing, Claims Management, Billing, Accounts Receivable Management, Systems Analyst and HIM functions for the entire network of physicians and practice sites.

Claims Management Responsibility:

• Thorough understanding of EDI standards for electronic claims submission.
• Demonstrate knowledge of third party payer requirements for billing specialty services (anesthesia, surgical, split component billing, and medicine specialties).

Credentialing Responsibility:

• Understand the role and responsibility for delegated credentialing status.
• Support and adhere to NCQA standards for credentialing.
• Ensure compliance with payer agreements as they relate to credentialing.

Accounts Receivable Management:

• Analyzes the various methodologies for reimbursement and their contractual impact across the organization.
• Works with Finance and Accounting on issues between sub-ledger and G/L.
• Manage charge master and pricing structure.
• Oversight of managing cost-based services (oncology drugs, hearing aids, supplies, etc.) to ensure reimbursement covers cost and acts as point of escalation on issues relating to these services.
• Denial management and develops analyzes to reduce controllable denials.
• Leads the management of the A/R to support the monthly cash targets.

Health Information Management:

• Provide leadership and guidance to continue coding and charge capture centralization.
• Collaborate with HIM Director to automate medical records functions.
• Provide high level leadership for ICD-10 implementation.

Technical Practice Management System:

• Oversee development of standard and ad-hoc reports.
• Direct the technical system work required to appropriately support clinical billing and reimbursement.
• Solid understanding of Epic and EPIC business tools, to include use of Resolute, Prelude, Cadence and MyChart.
• Provide leadership and direction to System Analysts regarding Epic.

Minimum Qualifications

The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education:

• Bachelor’s Degree in Business/Healthcare Administration.

Experience:

• Minimum of 8 years’ experience in a large academic group practice with emphasis on back-office functions (claims submission, A/R follow-up, customer service, and cash services).
• Comprehensive knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPS coding.
• Knowledge in healthcare compliance including privacy and security regulations, confidentiality laws, access and release of information.
• Demonstrated leadership qualities and abilities.
• Strong organizational skills with the ability to work on multiple, complex projects with high quality results.
• Excellent verbal, written and attentive listening communication skills.
• Must have ability to form working relationships with individuals at all levels of the organization. Strong positive interpersonal skills to collaborate with Senior Management, Physicians, and Executive level staff.
• Excellent analytical skills including the ability to analyze quantitative and qualitative information and reach sound conclusions.
• Ability to perform A/R statistical analysis, identify gaps, develop solutions and implement necessary changes for the achievement of key metrics (Days in A/R, aged receivable greater than 90 days, denial rate, bad debt percentage, and collection rate).
• Appreciation of timeliness with resolving issues and determining priorities. Strong planning and delegation skills including ability to develop and cross-train staff.
• Proficient with MS Office suite especially EXCEL and leveraging this tool to complete analyses.
• Knowledge of medical terminology, classification systems, and vocabulary.
• Demonstrates the values of the organization - Respect, Compassion, and Collaboration.
• Incumbent must have ability to effectively manage staffing resources to meet deadlines.
• Incumbent must also have ability to take initiative and make decisions remaining compliant with internal controls and standard operating procedures.
• Ability to maintain a professional demeanor and confidentiality is required.

Competencies:

• Ability to input data into the computer, and analyze data as requested. Must be able to communicate providing verbal feedback in a professional manner. Must be able to follow and understand instructions, and react favorably in all work situations. Must be mentally adaptable and flexible in dealing with a variety of people.

Supervision Received:

Broad supervision received from Chief Financial Officer.

Supervision Exercised:

Direct supervision over all Business Office/HIM/Credentialing staff.

Typical Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Frequent mobility and/or sitting required for extended periods of time. Requires manual dexterity to operate computer keyboard, calculator, copier machine, and other equipment.