Description
Summary of Position:
The Director of Revenue Cycle will lead the overall policies, objectives and initiatives of BHC MSO, LLC/Barton Health System's patient access, health information systems, billing and collections, and enhancement of payor contracting and relations. The Director manages daily activities as they relate to revenue cycle functions which includes but are not limited to billing, collections, customer service, charge master, charge integrity, revenue cycle analytics and reporting for the System. The Director is responsible to enhance and standardize work flow processes throughout the revenue cycle to achieve efficiency and consistency in revenue cycle performance, optimize AR management and collections in order to achieve revenue cycle performance objectives and organization strategic goals. The Director will be responsible for directing tasks, facilitating communication, managing interactions with stakeholders, and achieving support and agreement from involved parties and client revenue cycle operations.
Qualifications
Education:
• Bachelor's degree in Business, Finance, Accounting, Healthcare Administration or related field. Master's degree is preferred.
Experience:
• Five years related experience progressively responsible management experience in a revenue cycle director position within a multi-specialty healthcare organization.
• Minimum five years recent experience in insurance billing.
• Demonstrated experience with customer service and continuous quality improvement techniques.
• Experience establishing and maintaining a full month-end close cycle, including managing deadlines and verifying accuracy of information.
• Ability to manage a team effectively, in order to meet the goals of the organization.
Knowledge/Skills/Abilities:
• Knowledge of all functional areas of Revenue Cycle within a healthcare setting.
• Strong research and auditing skills.
• Ability to manage multiple projects and meet deadlines.
• Ability to analyze financial information and determine impact on the organization.
• Ability to identify and resolve issues in a timely and proactive manner.
• Knowledge of federal and state regulations.
• Knowledge of major federal and commercial payers.
• Denials Management, including reporting, accountability and resolution.
• Ability to analyze and review billing requirements and automate the billing process.
• Highly effective collaboration skills, written and verbal communications skills.
Certifications/Licensure:
• RHIT, RHIA, CCS-P or CPC required.
• CPA preferred.
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.
• While performing the duties of this job, the employee is frequently required to walk, stand, sit, and talk or hear.
• The employee is occasionally required to use hands to finger, handle, feel or operate objects, tools, or controls; and reach with hands and arms.
• The employee is occasionally required to climb or balance; stoop, kneel, crouch, or crawl.
• Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.
• The employee must occasionally lift and/or move up to 25 pounds.
Working Conditions
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Normal office environment. The noise level in the work environment is usually quiet to moderate while in the office.
• Occasional travel to various health system locations.
Essential Functions
1. Provides consistently exceptional care at all times.
2. Develop and implement an effective billing program to ensure timely, efficient, and accurate processing of claims; timely initial billing, follow-up, payment posting, denial management, self-pay A/R and bad debt program management.
3. Maintains accuracy and appropriateness of charge master and code sets for pertinent hospital departments and physician practices to include:
a. Annual charge master review and updates and/or recommendation based on area survey and CMS guidelines.
b. Reviews and updates ICD-9 and CPT code sets annual ensuring all coding is current according to CMS guidelines.
4. Oversees and manages all aspects of billing practices ensuring accuracy and compliance with standards, to include:
a. Charge entry
b. Claim submission & follow up
c. Patient balance billing
d. Banking
5. Demonstrates effective communication, conflict resolution, consultation, negotiation and collaboration skills; provides coaching, mentoring, support and consultation to managers, colleagues, and staff; serves as a role model in professional behavior and leadership skills, problem-solving ability and interpersonal skills.
6. Ensures staffing meets the needs of the organization and population served. Determines staffing levels. Posts open positions in a timely manner.
7. Ensures the competency of all staff. Determines standards of performance. Ensures staff is oriented to the hospital and department and performance meets expectations. Staff performance is accurately evaluated. All evaluations are completed annually and according to organizational timeframes. Develops & follows through with employee development plan when opportunity for improvement is identified. Promotes staff development and develops annual education and competency plan.
8. Develops and oversees department PI activities. Develops department goals and objectives. Determines departmental PI monitors. Organizes and oversees department projects utilizing FOCUS PDCA. Educates staff in PI methodology and promotes participation by all staff. Accurately prepares and reports departmental activities and findings as scheduled
9. Develops and manages budget according to organizational goals and objected and patient safety standards. Ensures annual budget review and revisions are completed as required. Reviews monthly departmental accounting detail for accuracy. Ensures report is corrected if needed.
10. Has extensive knowledge of all professional and regulatory standards that apply to department activities. Member of Compliance Team. Ensures ongoing departmental compliance. Develops and implements corrective action when deficiencies are identified.
11. Participates in and/or chairs committees, work groups, and meetings as appropriate.
12. Responds to the needs of the department by performing other duties, as necessary.
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