Director, Revenue Cycle

Job Summary

The Director, Revenue Cycle provides overall leadership, management and direction of the revenue cycle function. Responsibilities include but are not limited to DAR/Pulse documentation, Alert/APC edits, billing guidelines, uniform CDM, support system requests, external vendor systems, create and define strategic objectives and implementing process redesign, policies and measurement tools.

Essential Functions

• Defines and establishes strategic direction and priorities for the revenue cycle operations.
• Directs the management and operations of Revenue Cycle/Collections services to provide high quality cost-effective customer service.
• Works with leadership to implement best practice workflows and ensures adherence to policies and procedures as related to revenue cycle operations.
• Oversees all revenue cycle processes and ensures key metrics are met by analyzing data and optimizing performance.
• Responsible for ensuring all escalations related to daily operations revenue cycle are handled appropriately; notifying leadership as appropriate.
• Effectively leads, coaches, and counsels supervisors, managers, and other revenue cycle team members as necessary.
• Reviews action plans and educates supervisors, managers, and clinic operations teams (staff, providers, leadership) on proper follow up techniques.
• Reviews daily, weekly, and monthly clinic operations indicators and takes appropriate steps with leadership to address and improve.
• Audits transactions posted to patient accounts to ensure accuracy; educates where appropriate.
• Audits staff investigation and resolution of billing concerns; educates where appropriate.
• Audits and reconciles cash with Bank and General Ledger to insure proper controls and complete accountability of funds received.
• Participates in integration efforts for new practice management systems/vendors including on site training and installation of policy and procedures for revenue cycle or other related areas of responsibility (i.e. Ingenious Med Utilization).
• Responsible for routine on site review of daily practice operations; ability to assess and complete gap analysis of all work streams that intersect with revenue cycle working with corporate resources, clinic operations including leadership; and other area leaders to ensure all gaps are closed.
• Responsible to review monthly KPI’s and communicate problematic trends for intervention and resolution with corporate including leadership as appropriate.
• Responsible for working knowledge of payer fee-for-service contracts and value-based care contracts.
• Possess ability to work in a matrix environment where multiple or competing customer demands are likely.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Leadership Responsibilities

• Supervision and Staff Management
  • Provides leadership, mentorship and professional development opportunities for departmental staff.
  • Schedules employees to ensure effective use of resources. Consults with leadership on any potential staffing issues.
  • Conducts performance evaluations, sets goals and provides feedback to staff on their performance and development.
• Strategic Planning and Financial Oversight
  • Collaborates with hospital leadership to set the strategic direction for the department, including budgeting, resource allocation and long-term planning.
  • Monitors expenditures, ensuring cost-effective delivery of services.
  • Evaluates and implements new technologies to enhance operational efficiency.
  • Develops and implements departmental policies and procedures and protocols to optimize quality and overall efficiencies.
• Quality Assurance and Regulatory Compliance
  • Ensures compliance with all relevant regulatory bodies. May oversee the accreditation process with relevant agencies ensuring that services meet or exceed industry standards.
  • Participates in audits, inspections and accreditation processes as applicable.
  • Follows established quality control practices to ensure accuracy, consistency and safety.
• Collaboration and Communication
  • Works closely with leadership teams to coordinate and improve service delivery.
  • Stays up-to-date with industry advancements, new technologies, and regulatory changes.
• Staff Responsibilities
  • May work in a staff role, when required. Ensures that duties and responsibilities are fulfilled while meeting all competencies established for that job.

Qualifications

• Bachelor's Degree in relevant field required or
• Seven (7) plus years of direct experience in lieu of a Bachelor's degree required
• Master's Degree preferred
• 3-5 years of experience in closely related field with Bachelor's degree required
• 3-5 years of previous leadership experience preferred

Knowledge, Skills and Abilities

• Strong leadership, organizational, and communication skills.
• Ability to collaborate with interdisciplinary teams and manage cross-functional relationships.
• Foster a positive work environment that promotes teamwork, professionalism, and continuous improvement.
• Communicate effectively with leadership, team members, and stakeholders.
• Ability to work effectively with others, delegate responsibilities, and independently manage tasks while meeting established deadlines.
• Problem-solving and critical thinking skills.
• In depth knowledge of industry best practices and regulatory compliance (if applicable).
• Strong organizational and time management skills.
• Proficiency with Google and Microsoft platforms, healthcare software systems, and data analysis tools.

Licenses and Certifications

• CPB Certified Biller through AAPC preferred
• CMIS through PMI preferred
• CMRS through ABA preferred