Director of Revenue Cycle Management

Description

About Primary Health Solutions

Our Mission

We meet people where they are and partner with them on their journey towards wellness.

Our Vision

The destination for servant leaders to provide comprehensive and exceptional care.

Our Values

R – Respect

I – Innovation

S – Stewardship

E – Excellence 

Director of Revenue Cycle Management I Summary

The Director of Revenue Cycle Management I oversees all Revenue Cycle functions and will contribute to the day-to-day operations on all issues related to the revenue cycle, provide analysis, create written processes, and train others to establish a cross-functional Revenue Cycle team. 

This is a remote leadership position requiring the ability to effectively manage and develop a geographically dispersed (remote) revenue cycle team.

A Day in the Life

· Oversee the following revenue cycle functions including coding, charge capture, billing, payer enrollment, claims processing, payment posting, accounts receivable, and denial management.

· Monitor key performance indicators (KPIs) such as days in A/R, clean claim rate, denial rate, and net collection rate; implement corrective actions as needed.

· Oversee denial management strategies and appeals processes to ensure timely resolution.

· Analyze denial trends and implement process improvements to prevent recurrence.

· Ensure timely payer enrollment for all providers and collaborate with HR and operations to ensure providers are billing-ready by date of service.

· Ensure timely and accurate submission of claims in compliance with FQHC billing requirements leveraging multiple technical programs inside and outside of NextGen

· Review financial hardship applications (sliding fee scale). 

· Ensure timely and professional resolution of patient billing inquiries and complaints.

· Collaborate with Patient Access Department to support the front desk with insurance billing and sliding fee knowledge

· Collaborate with Clinical Operations and Practice Optimization teams to ensure EHR/clinical workflows are compliant with FQHC billing and all revenue opportunities are billed

· Collaborate with Quality Department to optimize quality program reimbursement

· Supervise internal and external Revenue Cycle personnel in various duties, such as A/R management, issue resolution with insurance plans, collections, cash posting, contract analysis, and billing. 

· Lead, coach, and develop a remote revenue cycle team across multiple functional areas.

· Oversee hiring, onboarding, training, and performance management.

· Works directly with payers and reviews payer contracts. Always negotiate for PPS methodology reimbursement with payer contracts. 

· Manage vendor relationships for RCM partners such as clearinghouse and external coders. 

· Attend internal NextGen committee meetings and contribute to cross-departmental projects

· Oversight/management of NextGen billing tables in file maintenance in partnership with NextGen host

· Performs all other duties and tasks as assigned. 

Core Competencies

· Customer Service: Committed to increasing customer satisfaction, sets proper customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met.

· Communication: Understand and communicate effectively with others using a variety of contexts and formats, which include writing, speaking, reading, listening and interpersonal skills.

· Dependability: Meets commitments, works independently, accepts accountability, handles change, sets personal standards, stays focused under pressure, meets attendance/punctuality requirements.

· Quality: Is attentive to detail and accuracy, is committed to excellence, looks for improvements continuously, monitors quality levels, finds root cause of quality problems, owns/acts on quality problems.

· Productivity: Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, and handles information flow.

Requirements

Success Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience

· Bachelor’s degree in healthcare administration, business, finance, or related field preferred

· Minimum of 7–10 years of progressive revenue cycle experience, preferably within an FQHC or community health setting.

· Experience with payer enrollment, billing compliance, coding, and payer relations.

· Demonstrated experience managing remote teams strongly preferred.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Reasoning Ability

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Computer Skills

To perform this job successfully, an individual should have the ability to gain knowledge of current practice management system, electronic medical record, Microsoft Word, text paging, Internet, and Intranet.

Other Applicable Requirements 

· Proficiency in electronic health records (EHR) and practice management systems (NextGen experience required).

· Sound knowledge of health insurance providers. 

· Ability to serve as a mentor and subject matter expert across the organization.

· Working knowledge of regulatory requirements pertaining to health care operations and their impact on operations. 

· Knowledge of professional fee billing, reimbursements and third-party payer regulation and medical terminology is required. 

· Expertise in information systems to ensure multiple information streams flow efficiently and correctly through a number of varying streams using complex, industry-specific applications.

· Ability to manage multiple priorities and meet deadlines in a dynamic environment. 

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 accommodation 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 stand; walk; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to sit and stoop, kneel, crouch, or crawl. The employee must regularly lift and /or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is occasionally exposed to fumes or airborne particles, toxic or caustic chemicals and risk of radiation. The noise level in the work environment is usually moderate.

EEO Statement

It is the policy of Primary Health Solutions to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information, or any other protected characteristic under applicable law.

Other Duties 

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.