Job Details

Description

JOB TITLE: DIRECTOR OF REVENUE CYCLE

REPORTS TO: CHIEF FINANCIAL OFFICER STATEMENT OF PURPOSE The Director of Revenue Cycle reports to the CFO and is responsible for the direction and leadership of operational, financial, programmatic, and personnel activities for Revenue Cycle, including provider enrollment, claims, payments, credit balance, insurance reimbursement, and self-pay management. This includes establishing, meeting and continuously monitoring the goals and objectives while maintaining alignment with the strategic goals and objectives for Sun Life Health. The Director will oversee the overall policies, objectives, and initiatives of Sun Life Health’s revenue cycle activities to optimize the patient financial interaction along the care continuum. The Director will monitor and evaluate alternative payment methodologies and recommend procedures to implement, as appropriate. ESSENTIAL FUNCTIONS Responsible for financial functionality of Patient Management System design and performance. Oversees the performance of our contracted billing service agent and ensures a high-performance level to maximize earned revenue potential. Work closely with other departments (HIM, Registration, Information Technology, Back Office (MA’s and Providers) to streamline procedures that will help ensure correct billing to patients and payers in a timely manner, thereby expediting receivables. Reconciles encounter reports with Medicaid managed care records and Medicaid prospective payment records and ensures that quarterly payments are not materially over or understated. Assists with contract negotiations with managed and non-managed care organizations. Contributes to staff results by planning, coaching, counseling, and by monitoring results. Completes all staff performance reviews by the due date. Completes operational requirements by delegating authority, scheduling, and assigning employes and following up on work results. Establish and maintain departmental polices and procedures. Communicate relevant information to other departments. Establish controls and review mechanisms to ensure procedures are being followed correctly. Monitor potential alternative payment methodologies to be prepared for potential implementation. Work with multiple departments to implement appropriate alternative payment methodologies. Collaborate with Revenue Cycle and Auditing and Coding Managers to plan, organize, and deliver regular staff meetings for the department. Assist the CFO in maintaining a cooperative relationship among SLFHC departments by communicating information, responding to requests, and participating in problem-solving methods. Promote excellence in internal and external customer service by maintaining consistent, timely communication regarding all facets of departmental activities with his/her co-workers at all levels of SLFHC. Develop and monitor departmental budget to achieve goals within budget. Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers. Develop, redesign, and monitor key performance indicators including payer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other requested parameters. Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers. Serves as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers. Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implanting solutions. Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks. Oversee the collection of medical services payments and reimbursements from patients, insurance carriers, financial aide, and guarantors. In conjunction with operations, reviews and enhances insurance verification, coding review, billing, collection, and payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current workflow.

Qualifications

KNOWLEDGE, SKILLS, AND ABILITIES Excellent verbal and written communication skills Excellent analytical and organizational skills Excellent Supervisory skills and interpersonal relation ability EDUCATION AND EXPERIENCE: Bachelor’s degree required; masters degree preferred. Minimum of seven (7) years of experience in revenue cycle management, enrollment, billing. payment processing, or similar operations required. Minimum of five (5) years of recent leadership or progressive supervisory experience required. Superior Knowledge of CMS, Payor credentialing and revenue cycle functions. Considerable knowledge of medical office operations, professional fee billing, reimbursement and third-party payer regulations and medical terminology is required. Knowledge of ICD-10 Codes, CPT Codes, HCPCS Codes, Revenue Codes, and Place of Service Codes. Prior experience with Federally Qualified Health Centers (FQHC), HRSA and public/community health agencies highly preferred.