POSITION SUMMARY: The Director of Revenue Cycle Management is responsible for the oversight of all claim development, claim submission, denial investigation, and collections/follow-up activity related to all company services and payer sources. The Revenue Cycle Management Director monitors accounts to reduce Days Sales Outstanding and improve cash flow. The Director of Revenue Cycle Management provides linkage to other department personnel to correct and resubmit billing, and if necessary, makes recommendations to leadership to write off account balances deemed uncollectable.

The Director of Revenue Cycle Management will work with organizational leadership on continuous performance improvement activities related to process redesign, training, and education to minimize rejections, denials, and bad debt write-offs. In addition, the Director of Revenue Cycle Management will work with organizational leadership on all new program development to ensure the ability to bill and collect for services rendered successfully.

KEY REPORTING RELATIONSHIPS: Reports to the CFO

ESSENTIAL DUTIES:

• Leads the overall development, interpretation, coordination, and administration of system policies governing all aspects of the revenue cycle.
• Drives continuous revenue cycle process improvement universally and largely standardized and aligned with industry best practice standards to achieve data-driven results.
• Develops, implements, and maintains strategies by working with internal and cross-functional partners to achieve optimal revenue cycle performance.
• Leads the billing team and ensures the correct NPI/taxonomy/billing code configuration is accurate.
• Plans and evaluates the day-to-day workflow of the billing office; sets priorities and goals for the billing manager and staff.
• Performs regular accounts receivable aging reviews with the billing team to monitor balances that are approaching unacceptable time frames or dollar amounts.
• Reviews claims for collectability, recommends claims for write-off, and calculates the Allowance for Bad Debt on a monthly basis.
• Works closely with key stakeholders in operations including admissions, clinical operations, and HIM to ensure efficient operations and streamline revenue cycle processes.
• Reports key Performance Indicators (KPIs) on a monthly basis. Continuously monitors the regulatory environments to ensure that payors evolving reimbursement structures, documentation requirements, and other requirements are evaluated and necessary changes in policies and procedures (and systems) are completed within the EHR.
• Initiates the development of new approaches to streamline existing processes, reorganize work, implement new technologies, and improve resource utilization as RCM links to the organization.
• Ensures that billing rates are updated per both Medicare and Medicaid guidelines and all commercial contracts, coordinating with other department leaders on maintenance.
• Recruits, trains, and mentors team members to cultivate high performance. Ensures cross-training and backup for each significant payer and critical task.
• Participates in continuing education and professional development. Participates in organization and community events and professional associations as required.
• Maximizes customer relationships and directly interfaces on collection matters and dispute resolution.
• Ensures that timely and accurate payment and account standing information is provided to leadership and management as needed and/or appropriate.
• Maintains a working knowledge of all revenue cycle management computer systems; works with internal IT staff and external software vendors to stay current with changes in technology; ensures all payer information is set up correctly.
• Participates in the monthly financial closing process to accurately capture Electronic Medical Record (EMR) totals for entry into the financial General Ledger (GL) system.
• Understands company processes, procedures, and policies and ensures adherence to company guidelines.
• Other duties and responsibilities as assigned.

CORE COMPETENCIES:

• Competent in all Microsoft Office products; advanced skills in Microsoft Excel and PowerPoint.
• Articulates with excellent verbal and written communication skills.
• Exhibits a strong commitment to dependability and reliability; ability to gain the confidence and respect of the customer base and holds a high degree of integrity, understanding the importance of sensitive and/or confidential information.
• Demonstrates the ability to think creatively, highly driven, and self-motivated.
• Possesses the ability to work with team members in a hands-on director capacity.
• Demonstrates aptitude to work independently using analytical thinking; possesses a strong understanding of business processes to deliver requested output timely and accurately.
• Manages multiple assignments simultaneously; remains organized, detail-oriented, and flexible in a fast-paced, challenging work environment.
• Demonstrates extensive knowledge and understanding of proper accounting treatment for accounts receivable transactions and activities.
• Supports the mission and values of hospice and palliative care.

POSITION QUALIFICATIONS:

Minimum Education: Bachelor’s degree required; master’s degree preferred.

Minimum Experience: Five to seven (5-7) years of finance, billing, and/or revenue cycle experience with increasing responsibilities required; with at least three years of managerial experience.

PHYSICAL REQUIREMENTS:

• Ability to lift/carry a minimum of 30 lbs.
• Prolonged, extensive, or considerable standing/walking/sitting.
• Occasional reaching/lifting/carrying.
• Manual dexterity and mobility
• Visual and auditory acuity

WORKING CONDITIONS:

• May be exposed to infections and contagious diseases.
• Exposure to a variety of electro-mechanical hazards
• Subject to varying and unpredictable situations
• Able to maintain job performance in emergency or crisis situations