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Associate Director will lead the Revenue Cycle Management team for the CenterWell Senior Primary Care Organization. This individual will manage a small internal team of associates and third-party RCM vendors that runs all RCM activities. Responsible for leading ongoing efficiency and effectiveness of the team through new processes, and technology. Maintaining all staff up to date on all state, federal and internal policies and procedures. Establishes industry best practices and KPIs for billing and, cash collections for both patient and payers. Innovative leader that will integrate new AI and automated solutions to drive efficiency and performance.

This role will report directly into the Associate Vice President, Central Operations. The Associate Director is responsible for internal revenue cycle management (RCM) teams and third-party RCM vendors. Responsible for leading ongoing efficiency and effectiveness of the team through new processes, and technology. Maintaining all staff up to date on all state, federal and internal policies and procedures. Establishes industry best practices and KPIs for billing and collections for both patient and payers.  Innovative leader that will integrate new AI and automated solutions to drive efficiency and performance.

Use your skills to make an impact
 

Job Functions

• Responsible for day-to-day operations of centralized RCM offerings and Medicare Advantage financial recoveries through health plan contestations process.

• Oversee the preparation of monthly reports on department activities including productivity, collections, status of accounts receivable and unbilled revenues.

• Lead RCM integration responsibilities for Mergers and Acquisitions and DeNovo medical centers

• Collaborate closely with all departments in the Primary Care Organization (including Operations, EMR/Technology, Clinical, Medical Coding, Credentialing, Contracting, Legal and Compliance)

• Facilitate revenue and receivable meetings between RCM leadership and business partners

• Ensure external vendor and internal RCM compliance with all billing and collections guidelines, hold them accountable to SLAs and manage KPI and metrics performance

• Support and/or lead the implementation of process, procedure and systems to drive value in the Centralized Billing Office (CBO) including EMR/PM systems.

• Maintain Standard Operations Procedures for RCM functions: claims management, accounts receivable follow-up, internal collections, collection agencies, vendors, bad-debt and administrative write-offs

• Ensure the timely and accurate production and distribution of patient bills and statements.

• Ensure patient questions and concerns managed by CBO are addressed in a professional and timely manner.

Required Qualifications

• Bachelor's Degree

• Must have 5 or more years of Revenue Cycle Management leadership experience

• This is a Remote position, travel less than >10%

Preferred Qualifications

• Thourough comprehension of third-party contracting terms with respect to Medicare (Traditional and Medicare Advantage), Medicaid, HMOs, PPOs, and a thorough knowledge of third-party billing and reimbursement.

• Previous experience in billing for Risk and FFS providers, preferably with senior primary care patient populations

• Demonstrated success in managing a large scale, high volume, complex billing and collections operation.

• Experience with clearinghouse relationships, third party billing and collections vendors, compliance and EMRs

• Lead with a clear orientation towards compliance in all aspects of the RCM process

• Highly effective written and verbal communication

• Analytical ability, conceptual skills to refine existing RCM operations and drive KPIs and metrics.

• Advanced Excel Skills

• Experience in project implementation

• Strategic and analytic skills oriented with the ability to perform root cause analysis and recommend improve processes and procedures

Additional Information

This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Benefits: Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1