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Director of Revenue Cycle

SUMMARY

Has responsibility to develop, plan, organize and implement current and future strategies for Patient Access, Appointment Scheduling, Patient Registration, Billing and Collections and Third-Party Enrollment.

KEY OBJECTIVES

Maximize point of service collections, maximize gross collection percentage, sustain ideal account receivable, create and maintain written policies and procedures in accordance to organization, HRSA and other contractual requirements, ensure current and complete insurance enrollment, cultivate and maintain third party relationship and negotiate and manage Medicaid, Medicare, insurance and other payee contracts.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  1. Develop and implement controls and measures to ensure accurate and timely billing and collections, in accordance with established internal and third-party payer requirements.
  2. Continuous Improvement in policies and procedures, also strategies and services (establish, record, implement) for all revenue cycle activities, including follow-up on third-party approvals and collection of overdue patient accounts.
  3. Analyze workflow and demand within the revenue cycle and set the organizational structure to meet this demand.
  4. Create and implement strategies to maximize revenue by providing best practice support for efficient processing of patients and scheduling of appointments.
  5. Manage and direct revenue cycle functions for all patient revenue streams, including insurance reimbursement, collections and patient payments.
  6. Manage actions relating to delinquent accounts, collection agencies, special adjustments, and/or write-offs.
  7. Generate projections and trends and analyze revenue information using Electronic Health Record reporting
  8. Align revenue cycle processes with organizational mission, setting budgetary and performance benchmarks and goals for Revenue Cycle and ensuring the team have clear expectations of the objectives.
  9. Report status trends to senior leadership and board members.
  10. Oversee process of resolving issues and outstanding problems concerning Accounts Receivable (AR) management and revenue cycle process.
  11. Monitor Payer Enrollment to ensure timely reimbursement
  12. Cultivate and maintain payer relationships
  13. Negotiate payer contracts and assure PCH and payers adhere to contract terms, PCH maximizes revenue through pay for performance and other payment incentives.
  14. Organize periodic external audits to prevent internal control weaknesses.
  15. Utilizing the support of Human Resources, ensuring the most competent candidates are identified and recruited for the organization.
  16. Utilizing the support of Human Resources, ensuring all staffed are assessed and developed to meet their maximum potential.
  17. Ensure all revenue cycle personnel are educated and involved in the performance of the organization.

SUPERVISORY RESPONSIBILITIES

Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include hiring and training new staff; planning, assigning, and directing work; evaluating performance, providing coaching and development, addressing concerns and resolving problems, and managing employee timecards and PTO requests.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The required skills listed above are representative of the knowledge, skill and or ability required. Reasonable accommodations may be made to enable an individual with a disability to perform the essential duties and responsibilities.

EDUCATION AND EXPERIENCE

Bachelor’s degree (in Healthcare Business Administration, Finance or other related field preferred). Masters and/or CPA preferred

  • Five to seven years of experience in Revenue Cycle
  • Four years minimum of management or supervisory experience
  • Healthcare Billing Laws, Medical Terminology/abbreviations
  • Professional Billing Policies, Procedures, Processes and Protocols
  • ICD-9, ICD-10, HIPAA and EHR implementation
  • Full Revenue Cycle Process including; Payer Enrollment, Scheduling, Registration, Accounts Receivable management
  • Medicaid, Medicare, and Sliding Fee programs
  • Electronic Health Record including functionality and reporting
  • Familiar with eClinicalWorks and Carelogic EHR preferred
  • FQHC or non-profit healthcare experience preferred

Skills & Interests:

  • Strong Customer Service
  • Organizational and Analytical Skills
  • Strong Communication skills with all levels of the organization
  • Team Building
  • Desire for Improvement
  • Superior Negotiation, and Decision-Making
  • Equal Opportunity implementer
  • Personal and Professional integrity

Email your cover letter and resume to: jobs@pchcares.org

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