Director of Revenue Cycle Management

Position Summary:

The Director, Revenue Cycle Management position is responsible for the billing team management (including processing claims), credentialing, patient information management, medical coding management, billing/revenue cycle management, collections and accounts receivable management, metrics and contract management.

Essential Functions and Responsibilities:

This list is not inclusive; other duties may be assigned such as the key projects assigned by your manager, but will include the following:

Medical Billing (Insurance Relations) - credentialing, medical billing, accounts receivable management and contract management to achieve highest possible collectable amounts while focused on speed to cash collection. Ongoing clinic coding training and or compliance issues are also managed. The company uses all internal billing personnel employed by Mercury and does not outsource any billing, credentialing or related medical billing work.

Billing Team Management

• Train, direct, manage current billing team andmonitorworkload for workload balance adjustment
• Evaluate staffing levels and add billers based on processing needs. Human Resources will recruit and interview billers/staff while the manager will be included in selecting
• Assistwith the development of creating position systems (manual) which include position requirements,expectationsand training.Also includes policy & procedures
• Monitor andassistwith AR’s, verifications, authorizations, insurance/patientpaymentsand patient accounts for allRenueclinics and managed service contracts
• Management clearinghouse batches and rejections
• Work AR’s and denials,resubmissionsand appeals. Handle patient disputes
• Process/set up and balance online patients’ payments
• Manageentire collectionprocess including submission to collection agency, adjustments, process payments to close the process
• Balance deposits
• Maintainelectronic medical record (EMR)by adding insurances
• Maintainmedical billing softwareby adding insurance, EFT/ERA enrollments,providersand clinics
• Prepare BCBS/BCBSMA deposits for CEO, COO and Controller

Credentialing

• Manage credentialingprocessfor all clinical staff working with all clinics. This is for allinsurancesbothgroupandindividual. Assist PT’s with CAQH updates and maintenance andassistPT’s with NPI
• By working with the COO,locatedapplicable credentialing software to reduce time to effectively manage submissions, process changes and periodically update records

Medical Coding Management

• Work with clinical and evaluate anddeterminebest in class billing methods and train clinical staffregardingCPT charges for various insurances

Billing/Revenue Cycle Management

• See billing team management above
• Stay current on insurance changes to educate patient account specialists (billers) and patient servicespecialists (clinic staff)
• Be a resource for PSS and billing staffregardinginsurance and authorization questions and any end of year changes

Collections and Accounts Receivable Management

• See billing team management above

Metrics & Reporting

• Track clean claims
• Process daily,weeklyand monthly reports, including month close reports and billing systems
• Weekly and monthly metric reports for McLaren Caro Region
• Prepare various reports for CEO, COO and Marketing as needed

Analytical Work

• Activity
• Performance
• Staffing Plans

Contract Management

• Monitor insurance payments for accuracy to contracts
• Obtain new contracts and work with other management team to improve overall performance
• Release contracts if appropriate
• Maintain insurance contact list
• Develop relationships with the management team to improve and seek higher reimbursement rates

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. 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.

Required: Proficient in all Microsoft Office applications as well as medical office software; proven experience in healthcare billing; sound knowledge of health insurance providers; strong interpersonal and organizational skills; excellent customer service skills; ability to work in a fast-paced environment.

Preferred: A professional who has a passion to deliver great patient care and experience.

Knowledge, Skills and Competencies:

Language Skills

• Communicate clearly and distinctly when answering phones.
• Communicate withpeopleofvarious social, cultural,economicand educational backgrounds.
• Demonstrated ability to read and interpretprofessionallevel documents written using advanced medical terminology in English.
• Demonstrated ability to produce clear and concise reports and correspondence at a professional level.
• Communicate fluently using StandardEnglish.
• Ability to effectively present information in one-on-one and small group situations to customers,clientsand other employees of the organization.

Computer Skills

• Demonstrated experience using computer applications, including electronic medical records, wordprocessingand email.