Job Description

Revenue Cycle Director
Providence, RI
100-125K

Duties / Responsibilities:

  • Direct all revenue cycle functions of the organization including billing and follow-up, insurance verification, professional staff and organizational credentialing, and related activities in a manner that minimizes days in accounts receivable while maximizing revenue realization. Manage outside billing relationships (if any) to ensure appropriate outcomes, timely reporting, and coordination of activities. Oversee management of pass-through Medicaid room & board billing, collections, and payments. Select, train/orient, and assign departmental staff (both directly and through subordinate staff) ensuring adequate staffing plan to provide timely, accurate, and customer-focused services.
  • Management of the organization's patient financial services policies & procedures including oversight and implementation of the organization's charity/free care, write off, accounts receivable reserve levels, and related policies & procedures. Work with patients, families, the admissions & referral center, physician and clinical leadership, social workers and staff on matters relating to insurance coverage to ensure strong customer relations while maximizing collections on accounts within organizational policies.
  • Supervise direct reports providing mentorship, technical guidance, training, and direction relating to short-term and long-term priorities and activities in order to maximize departmental outcomes, as well as staff personal growth and development. Facilitate/lead process improvement initiatives relating to departmental operations functions in order to improve customer satisfaction and efficiency/effectiveness of departmental functions.
  • Develop, measure, & report on measures of success and efficiency for departmental critical processes and workflow. Develop and manage operating/capital budgets for areas of responsibility, proactively identifying and pursuing opportunities to achieve best-practice operational and financial performance.
  • Ensure appropriate and up-to-date documentation of department policies and procedures for all areas of responsibility, as well as adequate documentation of internal controls that safeguard the assets of the organization and ensure accuracy of revenue cycle reporting processes. Develop mechanisms to ensure cross training and redundancy of departmental functions to minimize disruption during staff vacancies and time off. Develop and maintain well-documented plans, cross-training, and processes to ensure that all departmental critical processes have trained backup and SOPs in place so that core operations continue despite planned/unplanned absences, vacancies, and downtime.
  • Oversee establishment and maintenance of the financial elements (e.g., relevant data tables) of the patient accounting system/EMR to meet the organization's needs and provides complete and accurate records of services rendered, billing, payments, write-offs & allowances. Keep appraised of regulatory, payment, and other issues that impact/could impact the organization's revenue cycle performance in support of enhancement of the organization's fiscal health.
  • Serve as the lead contact with the organization's auditors for revenue-cycle related activities including information and analysis needed for the financial statement audit, tax return/form 990, and cost report working in close cooperation with the Controller.
  • Ensure organizational compliance with relevant regulations, standards, and rules as they relate to reimbursement and billing. Collect statistical data for administrative and regulatory purposes, ensuring complete and timely reporting as required by regulation or desired for reporting and analysis purposes. 
  • Act as key technical expert to organization (both management and staff) for issues relating to revenue cycle management, billing, and regulatory and contract compliance with respect to billing matters and such individuals and departments need for ongoing education and support. Interface with executive leadership, peers, management team, outside management consultants, and others on revenue cycle matters. Works in close cooperation with clinical leadership, information systems, health information services, clinical administrative support functions, clinical informatics, business development, materials management, and finance functions of the organization.
  • Serve as a role model, technical expert, and facilitator within the management team in a manner that maximizes success. Actively participate in and contribute to division-wide and organizational initiatives such as system implementations and upgrades, new program planning, and process redesign. Serve as designated expert on organization committees, staff supporting such committees.
  • Manage key vendor relationships including those for DME and pharmacy services. Monitor and manage third-party payor contracts to maximize payments and terms. Serve as a business office contact for long-term care, hospital, and other clinical service providers in a manner that maximizes customer and vendor satisfaction while working in close cooperation with the Business Development functions.
  • Serve as an active member of the COOP Committee and disaster planning activities with an ability and willingness to be on-site during times for emergency preparedness and periods of disaster/downtime including the potential for providing a physical presence for an extended period of time or at alternative sites.
  • Consistently apply the organization's values in all aspects of work, complying with established policies, procedures and objectives in quality assurance, safety, environment, and infection control.

Requirements:

  • Bachelor's Degree in Business, Finance, or related field. Equivalent, demonstrated practical experience in revenue cycle management in a complex health care environment may be considered in lieu of degree.
  • Minimum four to six years progressively-responsible experience in revenue cycle management and billing/collections experience in complex healthcare setting with extensive supervisory experience and knowledge of payor contracting, billing regulatory requirements, and patient information systems utilization and management.
  • Minimum two to three years' experience in hospice / home care environment strongly preferred.
  • Ability to work independently handling multiple projects and changing priorities with competing demands for resources in a fast-paced environment.
  • Extensive knowledge of patient accounting, related regulations and standards, leadership, and supervisory/management skills.
  • Advanced personal computing skills including Excel, as well as extensive experience with patient accounting/EMR systems. Strong written and verbal communication skills with focus on customer service and quality.
  • Demonstrated project management and organizational skills with demonstrated ability to work independently handling multiple projects and changing priorities with competing demands for resources in a fast-paced environment
  • Industry Experience
  • Strong Supervisory Experience
  • Billing/Collections
  • Minimum of 10 years progressive experience

Application Instructions

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