Director of Revenue Cycle

Essential Duties & Responsibilities

Leadership and Team Management:

•  Lead and mentor a team of billing specialists, ensuring they are motivated, trained, and equipped to perform their roles effectively.
•  Foster a culture of accountability, collaboration, and continuous improvement within the billing department.

Billing Process Management:

•  Develop and implement billing procedures and policies to ensure accuracy and efficiency in billing operations.
•  Monitor billing performance metrics and KPIs to track productivity, identify trends, and address any issues promptly.

Revenue Optimization:

•  Work closely with finance and accounting teams to reconcile billing discrepancies and ensure accurate revenue recognition.
•  Identify opportunities to optimize revenue collection processes and minimize billing errors.

Managed Care Contract Negotiation and Management:

•  Lead negotiations with managed care organizations to establish favorable contract terms and reimbursement rates.
•  Manage ongoing relationships with managed care partners, resolving issues and ensuring contract compliance.
•  Analyze contract performance and financial impacts, recommending strategies for contract optimization and revenue enhancement.

Compliance and Regulatory Oversight:

•  Stay informed about relevant regulatory requirements and ensure billing practices comply with industry standards and legal guidelines.
•  Implement internal controls to mitigate billing risks and maintain audit readiness. Job Summary: The Director of Billing and Managed Care will oversee and manage all aspects of the billing operations and managed care contracts within PCC Community Wellness Center. Responsibility will be to ensure accurate and timely billing to our customers while maintaining compliance with company policies and regulatory requirements. The Director of Billing and Managed Care will lead a team of billing specialists and collaborate closely with other departments such as finance accounting and effective management of relationships with managed care organizations to optimize revenue and ensure compliance to streamline processes and optimize revenue collection.

Cross-functional Collaboration:

•  Collaborate with other departments such as Finance, EHRS, Credentialing, and IT to resolve customer billing inquiries and issues.
•  Participate in cross-functional projects aimed at improving overall business processes and customer satisfaction.

Qualifications

Experience/Training:

•  Bachelor’s degree in Accounting, Finance, Business Administration, or related field or/equivalent to 5 years of experience in billing management or a similar role. Preferably in the healthcare industry.
•  Strong leadership skills with experience in managing and developing a high-performing team.
•  In-depth knowledge of billing procedures, accounting principles, and regulatory standards.
•  Excellent analytical and problem-solving abilities, and detail oriented.
•  Effective communication skills to interact with internal teams, clients, and stakeholders.
•  Proficiency in billing software and ERP systems (e.g., SAP, Oracle) preferred.
•  Certification in Billing or Revenue Management (e.g., Certified Billing and Coding Specialist) preferred.
•  Strong knowledge of healthcare billing regulations (e.g., Medicare, Medicaid, HIPAA) and managed care contracting principles.
•  Proven track record in negotiating managed care contracts and optimizing reimbursement rates.

Physical Demands:

•  Must be able to remain in a stationary position 50% of the time.
•  Must be able to move around the clinic site 50% of the time.
•  Constantly operates a computer, computer printer, copy machine, and telephone.
•  Occasionally positions self to maintain exertion of physical strength to move objects of 10 pounds from one level to another.
•  Must be able to transport from one site to another.

Language Skills:

•  Ability to read and write proficiently using the English language.
•  Excellent written and oral communication skills.

Software Knowledge:

•  Microsoft Office 2007/2010
•  Inuvio Software preferred