Revenue Cycle Director - TRH

The Revenue Cycle Director reports to the CFO and is responsible for overseeing and coordinating all revenue cycle activities with a goal of maximizing reimbursement in a cost-effective manner that is compliant with federal, state and payer-specific billing requirements. The Director will oversee the overall policies, objectives, and initiatives of the hospitals’ revenue cycle activities to optimize the patient financial interaction along the care continuum.

Job Duties:

• Oversee and support the daily operations of all PFS functions, including billing, follow-up and collections, cash posting and all Patient Access areas (Outpatient Registration and ER Registration).
• Work closely with other departments (HIM, Case Management, Information Technology, Nursing, and Ancillary departments) to streamline procedures that will help ensure correct billing to patients and payers in a timely manner, thereby expediting receivable resolution.
• Ensure timely and accurate submission of claims and the effective management of accounts receivable to maintain optimal cash flow.
• Direct the selection, supervision and evaluation of staff. Ensure performance evaluations are conducted in a timely manner according to hospital policy and initiate disciplinary actions as warranted. Resolve grievances and other sensitive personnel matters.
• Oversee orientation and continuing education for all staff. Ensure mandatory and relevant training is provided to staff in a timely manner.
• Monitor regulatory changes that impact revenue cycle operations and ensure compliance with federal, state and payer guidelines.
• 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.
• Collaborate with Billing, Collections, and Patient Access Managers to plan, organize, and deliver regular staff meetings for the department.
• Assist with the development of budgets and monitoring of department operations to achieve goals within budget.
• 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.
• Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Maintain appropriate internal controls for the safeguarding of cash.
• 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.
• Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.
• Serves as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implanting solutions.
• Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks.
• Responsible for maximizing the collection of medical services payments and reimbursements from patients, insurance carriers, financial aid, and guarantors.
• In conjunction with operations, reviews and enhances insurance verification, coding review, billing, collection, and payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current work flow.

Education:

• High School Diploma or Equivalent
• Bachelor’s Degree in related field is preferred – experience in lieu of education may be substituted

Training/Experience:

• Bachelor’s degree in Business, Healthcare Administration or related field preferred or equivalent combination of experience and education.

Skills/Qualifications:

• 5+ years of progressive revenue cycle experience to include Medicaid, Medicare and Third-Party reimbursement preferably in a rural environment.
• Demonstrated mastery of critical thinking, analytics, problem-solving and sound decision-making skills
• Established leadership and management skills, effective communication skills, professionalism, integrity, responsibility and dependability.
• Knowledge and experience with CPSI and Quadax software preferred but not required.
• Proficient in Microsoft Office products, specifically Excel
• Proven leadership skills and ability to gain cooperation and support from a diverse body of individuals
• Highly dependable in both production and attendance
• Ability to effectively prioritize and execute tasks while under pressure; make decisions based on available information and within the scope of authority of the position; excellent customer service skills, including professional telephone interactions.
• Exceptional organization, problem solving, and time management skills with an attention to detail
• Excellent verbal and written business communication skills sufficient to clearly document issues and effectively communicate.
• Promote the mission, vision, and values of Taylor Regional Hospital.
• Maintain confidentiality of all patient, medical, financial, and legal information.
• Represent the organization in a positive amp; professional manner.
• Ability to handle difficult situations involving patients, physicians, staff and others in a positive and professional manner.
• Comply with all organization policies and standards
• Consistently demonstrate the value of team concept.
• Understands and abides by OSHA, HIPAA and CLIA standards
• Understanding of HIPAA regulations and proven ability to ensure confidentiality with respect to sensitive information