Revenue Cycle Director

Memphis, TN, United States

Job Description Job Description Description: Position Summary :

The Revenue Cycle Director is responsible for managing the Practice and ASC Revenue Cycle. This position works to optimize the collection of payments for services rendered in the practice and ASCs. The position works collaboratively with the CEO, CFO, entity owners, and fellow employees to build/manage a successful, cohesive, high quality medical organization.

Essential Skills/Responsibilities:

· Coordinates with other affiliated RCM managers (external practices) to streamline the patient billing process and improve the customer service experience for patients and other persons/entities with financial responsibilities.

· Contributes to the organization’s business planning process.

· Coordinates the transition, training, and implementation of new billing services for the PPMS model.

· Reviews and evaluates proposed insurance contracts for the Clinic and ASCs.

· Maintains and monitors third party payer contracts to ensure proper and timely payment.

· Maintains ongoing contacts with representatives of all of the entity’s current and potential payers to assure that the entity’s current payments are aligned with contractual allowances and to facilitate periodic contracting efforts with potential payers.

· Coordinates the preparation, maintenance and periodic revisions of the patient accounts section of the entity’s operational manual; participates in the periodic review of the entity’s staff policy manual.

· Reviews rules and regulations for Medicare, Medicaid, and other contract insurance companies to ensure billing compliance, and when necessary, revises current billing procedures for the Clinic and ASCs.

· Coordinates and controls all data requested for Medicare and other agency audits. Works with the audit consultants to identify the problem areas and requests any training needed to correct the errors.

· Supervises and trains Clinic Revenue Cycle staff. Requires knowledge of the details of patient accounts: to post charges, submit claims, post payments, file secondary claims, challenge claim denials, execute collection procedures, etc.

· Monitors, completes, and implements Performance Review and Enhancement: Develops volume performance goals (in terms of AR ratio, revenue and claims

processing per clerk per year, etc.) and directs the resources required to meet those goals. Intervenes as necessary if performance lags agreed upon levels.

· Establishes and documents reasonable performance standards for each area of the Revenue Cycle office, trains accordingly to meet the standards, and monitors ongoing performance.

· Provides and ensures Doctor/Nurse/Tech Education: Works with providers and clinical staff to assure that all charges are properly documented, captured and timely submitted for payment while identifying areas of deficiency and implementing changes accordingly.

· Coordinates and directs in-service training programs for Clinic Physicians and Revenue Cycle staff.

· Works with physicians and their staff to correct any fee ticket errors and/or missing information to facilitate timely billing of these problem tickets for the Clinic and ASCs.

· Schedules coding and billing compliance seminars for staff so they are aware of changes that affect their area of responsibility.

· Plans and manages departmental budgets, as well as, monitors defined volume and performance targets.

· Demonstrates attention to operational detail and smooth daily operation in a complex and changing environment.

· Directs all billing, insurance and patient account/collection operations to maximize collection of accounts receivable ensuring optimum cash flow for the Clinic and ASCs.

· Works collaboratively with RCM team on issues that affect the Revenue Cycle office or the overall efficiency of the practice/ASC.

· Reviews for approval all refund requests for the Clinic and ASCs.

· Reviews and approves all forms to ensure they meet documentation requirements for the Clinic and ASCs.

· Monitors inventory to ensure that all injections administered in the Clinic are being billed and that we are being reimbursed correctly.

· Works with appropriate departments regarding necessary format changes to forms/consents/documents and Clinic electronic transmission requirements; continuous training to maximize the effective use of the practice management software by employees.

· Reports and Forecasts: Coordinates with the CEO and CFO to periodically prepare various entity specific financial reports. Prepares the daily, weekly and monthly computer generated financial reports. Reviews the aged trial balance report monthly with the CFO. Prepares and helps interpret monthly graphs showing over time the accounts receivable ratio and other key performance indicators.

· Prepares and audits Clinic and ASCs month end reports and custom reports that may be requested by Administration.

· Reviews and analyzes Clinic and ASC AR Reports to identify problem accounts in the Clinic and ASC and counsel collectors on correcting their problem areas.

· Assists with Work Flow Engineering: In coordination with the CFO and other assigned personnel, work to develop and continually fine-tune the complex flow of events, from the entry of patient demographics and entry of charges through claim submission, tracking and payments for the clinic and ASC.

· Serves on the Practice Management Committee composed of other Department managers, CEO, CFO, and Managing Partner.

· Analyzes Clinic and ASC claims submissions to project weekly collection amounts.

· Reviews and approves Clinic and ASC accounts to be turned over to the collection agency.

· Provides updated insurance allowed amounts for the Clinical practice and ASCs to office staff for accurate collection of deductibles and co-insurances.

· Communicates internally with all ESG/PASCH/PPMS staff.

· Communicates externally with patients, banks, etc.

· Completes all compliance training requested by company and required by law.

· Adheres to HIPAA Compliance plan.

· Travels to all clinical locations as needed.

· All other duties as assigned.

Requirements: Job Specifications/Competencies:

Education/Training:

Bachelor’s Degree and one to two years related experience; OR five to seven years RCM experience and/or training; OR equivalent combination of education and experience in RCM.

Demonstrated knowledge of third-party payers, collection laws, and procedures. General knowledge of Medicare regulations/requirements and experience with budgeting/analysis.

Skills:

· Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

· Demonstrated excellence in verbal communication, as well as, written communication.

· Good interpersonal and customer service skills.

· Critical thinking skills for identifying problems and resolutions in a fast-paced environment.

· Ability to calculate figures and amounts such as discounts, interest, commissions, percentages, area, circumference, and volume.

· Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical or complex instructions and deal with several abstract and concrete variables.

· Proficient in common business software; EMR preferred.

· Keyboard skills.

Attributes:

· Represents practice in a positive and professional manner.

· Punctual.

· Team player; willingness to help other staff.

· Attention to detail while multi-tasking.

· Diplomacy and confidentiality with patients and staff.

· Strong work ethic.

· Initiative/Self-Motivation.

Physical Requirements:

· Ability to sit/stand/walk as the job requires for long periods of time, as well as, climb/balance, lift, push/pull and stoop/crouch as needed.

· Corrected or uncorrected visual acuity in at least one eye of 20/40 or better.

· Ability to operate office equipment requiring the use of one hand.

· Ability to work in a moderate noise level clinic.

· Corrected or uncorrected hearing/speaking capacity to enable suitable telephone communication skills.

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