Director of Revenue Cycle
Job Details
Senior
Family Health/La Clinica-Stevens Point - Stevens Point, WI
Full Time
4 Year Degree
Negligible
Day
Finance
Description

This position directs and oversees the overall policies, objectives and initiatives of the complete revenue cycle activities for FHLC. The Director will oversee the strategic direction, goal setting, and performance management of the revenue cycle processes, encompassing the best practices related to the use of technology and analytics, as well as practice management processes. The position works closely with Finance and all clinical departments in the coordination of accurate data gathering, proper reimbursement, and prompt and high-quality patient service. The Director oversees the centralized scheduling, intake, coding, and billing processes for all areas, to ensure that payor requirements are met, and the patient experience is positive.

 

  • Directs and oversees the overall policies, objectives, and initiatives of the revenue cycle activities to optimize the patient financial interaction with FHLC. Specific areas of oversight are centralized scheduling, patient access (registration and benefit navigators), coding, and billing.
  • Propose and implement policies and procedures, work rules and performance standards to ensure the efficient and effective operation of FHLC’s Revenue Cycle departments in compliance with organizational standards and federal, state and local laws.
  • Maintain appropriate internal controls over accounts receivables/cash receipts; monitoring charge posting, billing, and collection operations for compliance with established policies, regulations, procedures, and standards; and establishing benchmarks for “Days in Accounts Receivable” based on Federally Qualified Health Center industry standards
  • Design, implement and monitor all key performance indicators to ensure that cash flow is maximized throughout the revenue cycle.
  • Develop, plan, organize, and implement current and future best practices for revenue cycle scheduling, intake, coding, billing, collections, denial management and other functions.
  • Continually identify opportunities for enhancement of revenue capture processes and correct any operating issues that are hindering the timely receipt and posting of payments and maximization of cash flow.
  • Collaborate and coordinate with practice managers and department directors regarding front desk operations related to billing, cash management, collections activities and revenue cycle processes
  • Consult with Quality / Compliance Department on questions related to coding and documentation criteria and collaborate with compliance on auditing and monitoring activities.
  • Work collaboratively with other leaders on revenue cycle performance to meet strategic goals and develop guidelines, policies, and procedures through use of data analysis.
  • Continually monitor billable revenues to budget, identify and explain significant variances for all revenue streams.
  • Coordinate and lead regular billing management meetings; conduct detailed review of key performance indicators and tends within accounts receivable for all programs.
  • Coordinate and lead regular scheduling and registration management meetings; conduct detailed review of key performance indicators and tends for all service lines and locations.
  • Responsible for department’s personnel action including hiring, training, retention, evaluation, and corrective actions.
  • Keep abreast of current and future external payer trends and continually evaluate and establish all operational changes necessary to ensure maximization of revenue capture in light of changes in industry reimbursement streams.
  • Address patient concerns, complaints, discrepancies related to revenue cycle actions which are not resolved at the manager/staff level first.
  • Ensures strict compliance of HIPAA privacy rules by personnel. Ensure that business processes are designed to ensure the confidentiality of patient protected health information and meet HIPAA standards.
  • Manage health center’s payer contracts and insurance credentialing, to include, but not limited to:
    • Develop payer contracting strategy and facilitate the negotiation of contract terms and rates with health plans and commercial payers.
    • Anticipate the impact of contract changes and communicate to CFO
    • Oversee communications to payers for contract negotiations, policy clarifications, issues resolution and updates.
    • Collaborate with CFO to analyze payment trends and utilize findings in new or existing contract negotiations.
  • Tracks numerous metrics related to the patient engagement cycle including intake errors, billing / coding error rates and billing turnaround times to develop sound revenue cycle analysis and reporting.
  • Plans and prepares monthly revenue reports for review and utilization by CFO.
  • Perform regular billing and coding audits, including compliance audits.
  • Maintain strong working knowledge of FQHC revenue cycle management, applicable Federal and State laws and regulations, all aspects of third-party reimbursement policies and practices, and knowledge of Current ADA, CPT, HCPCS & ICD-10 coding.
  • Serve as a subject matter expert for department managers, staff, physicians, and administration for obtaining information or clarification on documentation standards, state and federal law, and regulatory requirements relating to coding and billing.
  • Assist in the development of a revenue cycle departmental budgets and is responsible for managing the department within the established budget.
  • Performs other duties as assigned.

 

 

Qualifications
  • Bachelor’s degree in business related field
  • Strong, in-depth knowledge of revenue cycle management principles and practices including medical and dental billing, coding, collections, managed care products, regulatory compliance, payor enrollment/credentialing, and financial reporting
  • 5 years of experience in non-profit Billing and Revenue Cycle; preferably in an FQHC setting. Minimum of 3 years Managerial/Supervisory experience in billing operation.
  • Ability to lead, influence, and work collaboratively with others, develop and maintain strong relationships throughout all levels of the organization.
  • Ability to multi-task and prioritize tasks, projects, and demands with a sense of urgency and positivity
  • Champion new initiatives, serve as a catalyst for change, and influence others to accept and embrace change
  • Knowledge of business management and basic accounting principles to direct the billing and coding office.

 

English and Spanish language preferred but not required. Ability to read & interpret documents, reports & correspondence. Ability to speak effectively before groups and/or individuals.

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