Director of Revenue Cycle

Description

The Director of Revenue Cycle is responsible for overseeing all aspects of the revenue cycle process within the healthcare facility. This includes patient registration, insurance verification, medical coding, billing, accounts receivable management, and revenue optimization initiatives. The Director ensures the efficient and compliant operation of the revenue cycle to maximize revenue capture, minimize denials, and optimize cash flow. Additionally, the Director collaborates with internal stakeholders and external partners to drive continuous improvement efforts and achieve financial goals.

Leadership and Management:

• Provide strategic direction and leadership to the revenue cycle team, including billing specialists, coders, payment posters, and other staff members.
• Establish performance goals, KPIs, and metrics for revenue cycle operations and monitor performance against benchmarks.
• Foster a culture of accountability, teamwork, and continuous improvement within the revenue cycle department.
• Ensure an effective on boarding and training experience for new hires.

Revenue Cycle Operations:

• Oversee patient registration processes to ensure accurate demographic and insurance information capture.
• Manage insurance verification procedures to confirm coverage eligibility and benefits for patients including the 340 B Program.
• Monitor medical coding practices to ensure accurate code assignment and compliance with regulatory requirements.
• Direct billing activities, including claim submission, follow-up, and resolution of claim denials and appeals.
• Implement effective accounts receivable management strategies to reduce aging and optimize cash collections.
• Conduct regular audits and reviews of revenue cycle processes to identify areas for improvement and implement corrective actions as needed.

Financial Analysis and Reporting:

• Analyze revenue cycle performance metrics, including days in accounts receivable, clean claim rate, denial rate, and net collection ratio.
• Generate and interpret financial reports to assess revenue cycle effectiveness, identify trends, and make data-driven decisions.
• Develop financial forecasts, budgets, and projections related to revenue cycle operations and cash flow management.

Compliance and Regulatory Compliance:

• Ensure compliance with healthcare regulations, billing guidelines, and payer requirements, including HIPAA, Medicare, Medicaid, and commercial insurance policies.
• Conduct regular reviews and audits of revenue cycle processes to ensure adherence to regulatory standards and minimize compliance risks.
• Collaborate with compliance officers and legal counsel to address regulatory inquiries, audits, and investigations related to revenue cycle activities.

Stakeholder Collaboration:

• Collaborate with internal stakeholders, including clinicians, administrators, finance personnel, and IT staff, to streamline revenue cycle processes and address operational challenges.
• Liaise with external stakeholders, including insurance payers, patients, vendors, and regulatory agencies, to facilitate communication, resolve issues, and negotiate contracts.  

• Be a positive role model for all health center staff.
• Other duties as assigned.

Supervisory Duties:

• Billing Manager
• Credentialing Coordinator

Requirements

Knowledge, Skills & Abilities:

• Comprehensive knowledge of all available services provided at Third Street Family Health Services, community resources, interpersonal communication strategies, and computer software.
• Communicating effectively in both written and verbal form, managing multiple priorities, effective time management practices, problem-solving skills, and managing change and conflict.
• Ability to develop trust and effective working relationships with staff members, individuals, families and external and internal professionals.
• Ability to coach and mentor staff effectively.
• Strong information gathering/interviewing techniques.
• Effective leadership abilities including conflict resolution strategies and coaching skills. 
• Understanding of employment law. 

Qualifications:

• Valid driver’s license and reliable transportation
• Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field; Master's degree preferred.
• Minimum of 3 years of progressive leadership experience in revenue cycle management within a healthcare setting.
• In-depth knowledge of healthcare revenue cycle processes, including patient regist