Revenue Cycle Director

CALDWELL MEDICAL CENTER

JOB DESCRIPTION

JOB TITLE:  Revenue Cycle Director

DEPARTMENT:  Patient Financial Services

REPORTS TO:  Chief Financial Officer

SUPERVISES:   Patient Financial Services & Patient Access

POSITION SUMMARY:

• Is responsible for overseeing and coordinating all revenue cycle activities with a goal of maximizing reimbursement in a cost-effective manner that is in compliance with federal, state and payer-specific billing requirements.
• Functions under the supervision of Chief Financial Officer.
• Will oversee the overall policies, objectives, and initiatives of our healthcare facilities’ revenue cycle activities to optimize the patient financial interaction along the care continuum.
• Ensures appropriate organizational practices are in use.
• Promotes good public relations through contacts with patients, practitioners, visitors, employees, peers and the public at large.
• Maintains confidentiality of patient information.

POSITION RESPONSIBILITIES

ESSENTIAL FUNCTIONS:

1. Oversee and support the daily operations of all PFS functions, including billing follow-up and collections and cash posting.
2. Work closely with other departments (HIM, Case Management, Information Technology, Nursing, Patient Access and Ancillary departments) to streamline procedures that will help ensure correct billing to patients and payers in a timely manner, thereby expediting hospital receivables.
3. Establish and maintain departmental policies and procedures.  Communicate relevant information to other hospital departments.  Establish controls and review mechanisms to ensure procedures are being followed correctly.  Recommend policy changes to the Chief Financial Officer.
4. Respond personally to concerns and/or complaints expressed by patients, visitors, hospital staff, and physicians in effort to support optimal operations and excellent customer service.
5. Ensure compliance with relevant regulations, stands, and directives from regulatory agencies and third-party payers.
6. Maintain appropriate internal controls for the safeguarding of cash.
7. Follow and monitor compliance with hospital policies and standards.
8. 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.
9. Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.
10. Serves as the subject-matter expert on regulatory, compliance and legal requirements associated with medical billing and CMS.  Ensures compliance with relevant regulations, stands, and directives from regulatory agencies and third-party payers.
11. Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implementing solutions.
12. Responsible for maximizing collections of medical services payments and reimbursements from patients, insurance carriers, financial aid, and guarantors.
13. Learns & Implements contract management module within Trubridge and monitors & reports underpayments to CEO, CFO and Ovation Healthcare managed care service team.
14. In conjunction with operations, reviews and enhances insurance verification, coding review, billing, collection, and payment posting process for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current work flow.
15. Monitors daily production of claims, denials, and appeals.
16. Analyzes claims, utilization, and medical cost data.
17. Monitors aged accounts and verifies appropriate collections procedures are being followed. 
18. Reviews, monitors and recommends updates to the fee schedules to maintain fees at levels that maximize reimbursement.
19. Ensures compliance with relevant federal, state, and payer-specific billing requirements.
20. Regularly provides upper management with revenue cycle status including reports, metrics, and presentation.
21. Ensure staff is educated on new technology, goals, and contracts.
22. Lead the already established regular scheduled revenue cycle and denial committee meetings.  Discuss strategies and ensure everyone is educated on the direction of the department.
23. Work with Ovation Healthcare and our managed care contract team in identifying any payer relation issues or contracts that need to be renegotiated.
24. Follow up on unpaid bills.
25. Reviews patient registrations for errors and make corrections.
26. Enter Medicare and Medicaid bad debt and inputs into an Excel spreadsheet.
27. Enter and post cash PRN.  Hospital billing supervisor is first backup.
28. Enter adjustments and post PRN registration.
29. Complete ABS.
30. Processes patient refunds.
31. Review Explanation of Benefits from insurance companies for proper payment and adjustments.
32. Performs billing runs and generates UB92’s.
33. Assists in maintaining departmental reports and records as directed.  
34. Works cooperatively with others.  Has respect for and an understanding of the contributions of all team members.
35. Attends required meetings and actively participates on committees.  
36. Protects patient confidentiality by promoting appropriate staff communication practices.   
37. Performs other duties as assigned. 

POSITION QUALIFICATIONS

MINIMUM EDUCATION

5 years’ experience in hospital billing.

PREFERRED EDUCATION

Bachelor's Degree in a business-related field or five (5) or more years of relevant leadership experience in a hospital setting. Candidates meeting either qualification will be given equal consideration.

MINIMUM EXPERIENCE

1 – 2 years

PREFERRED EXPERIENCE

3- 5 years