The Director of Revenue Cycle, under direction of the Chief Financial officer, provides leadership, direction, and administrative oversight to all hospital leadership for revenue cycle functions such as: Patient Access, Financial counseling, Scheduling, Referral management, Revenue integrity, Charge description manager, Payer Contracting, Reimbursement, Facility and professional billing, Accounts receivable and collections processes. Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.
Plans and directs the activities of the Patient Financial services department, Patient Access ( including switchboard and financial counseling), Call Center, Referral Center and Professional billing services.
Creates and implements policies and procedures to promote effective patient account processes to ensure customer satisfaction and revenue cycle operational effectiveness.
Responsible for oversight of the Charge Description master to ensure compliant billing practices for both facility and professional billing services.
Responsible for oversight of all registration, scheduling, referral and billing processes for the organization.
Evaluates and ensures appropriate and compliant collection policies and procedures.
Manages the revenue cycle vendors to optimize the financial impact of the facility.
Responsible for Managed care contract maintenance, negotiations and analysis of contract performance.
Responsible for determination of personnel requirements for Revenue cycle departments.
Assesses, identifies and defines areas of opportunity for reengineering processes to improve the management of the revenue cycle and cash flow.
Provides direction and oversight for the implementation of key internal controls and procedures supporting the integrity of the revenue cycle and other business operations.
Supports all charge generating departments in developing processes and tools to ensure accurate and timely processing of unbilled receivables and charge capture.
Responsible for assessing and implementing appropriate training programs to meet organizational and customer expectations.
Develops and provides, in conjunction with IT, adequate and accurate reporting tools for monitoring and validating revenue cycle performance.
Responsible to maintain Accounts receivable at appropriate levels for both hospital and professional billings.
Provides guidance to administration and clinical departments on expected reimbursement for new programs/services being evaluated.
Responsible for having a working knowledge of CMS guidelines and stay apprised of reimbursement/payment changes and reform and provide guidance to the facility on how to meet these regulations.
Responsible for maintaining compliance with Provider Based billing regulations.
Responsible for achieving satisfactory obligations of MSO contracts and ensuring positive relationships with those providers.
Responsible for maintaining compliance with 501r regulations for the organization.
Maintains a close working relationship with the Finance department of the hospital and the facility and professional health information management departments.
Facilitates the monthly Revenue cycle committee meeting.
Works independently and manages multiple projects simultaneously.
Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.
DEPARTMENTAL AND ADDITIONAL JOB RESPONSIBILITIES
- Performs other duties as assigned.
JOB SPECIFICATIONS
EDUCATION
Master's Degree in Accounting, Finance, Business Administration or Healthcare Administration is required.
Certified Healthcare Finance Professional (HFMA), Certified Revenue Cycle Professional (HFMA) or Certified Revenue Cycle Specialist (AAHAM), preferred.
EXPERIENCE
Minimum of five (5) years' experience managing or directing hospital and or physician practice Accounts Receivable required.
Minimum of five (5) years experience managing or directing hospital registration and scheduling departments required.
Experience in processing referrals for physician practices highly preferred.
Knowledge of CMS and third party payer regulations and policies related to revenue cycle operations required.
Managed Care contracting experience highly preferred.
Experience with Microsoft Excel and Word required.
Demonstrated experience in leadership with exercising judgement in problem solving.
ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS
These physical requirements are not exhaustive and additional job related physical requirements may be added on an as needed basis. Corrective devices may be used to meet physical requirements.
Sedentary Work: Frequently required to stand, kneel and crouch. On a daily basis may be required to move about, sit, climb stairs and bend. Is frequently required to lift and carry up to 20 lbs. May be required to push/pull/carry items between 20-100 lbs.
Vision: Requires the ability to perceive the nature of objects by the eye. Near acuity: Clarity of vision at 20 inches or less. Midrange Acuity: Clarity of vision at distances of more than 20 inches and less than 20 feet.
Motor Coordination: While performing the duties of the job, it is required to regularly perform functions that include using hand and finger movement, handle or feel objects, be able to use tools or equipment that requires reaching with hands and arms. Must be able to travel independently throughout the hospital; access patients/families including areas confined by space and/or equipment.
Speaking/Hearing: Ability to give and receive information through speaking and listening.
ESSENTIAL TECHNICAL ABILITIES
Proficiency using modern office, computer and telephone equipment as used by Memorial Healthcare.
ESSENTIAL MENTAL ABILITIES
Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.
Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws.
ESSENTIAL SENSORY REQUIREMENTS
Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals.
Able to hear for work-related purposes.
INTERPERSONAL SKILLS
Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner, at all times, physically, verbally and in all written and electronic communication.
Required to remain calm when adversity is encountered.
Open, honest, and tactful communication skills.
Ability to work as a team member in all activities.
Positive, cooperative and motivated attitude.