Director of Revenue Cycle

Description

Job Description 

Job Title:   Revenue Cycle Manager  Employment Status:  Salary (Exempt) 

Department:  Finance Reports To: Chief Financial Officer 

MISSION STATEMENT: Leading adolescents to a new legacy. 

The mission of CLEARFORK ACADEMY is to offer the highest quality and professional, substance abuse and mental health treatment across a full continuum of care.  

We are committed to treating patients and their families with the highest regard and respect as clients work toward reaching their highest growth potential in their recovery process. This is accomplished through the strict adherence to the highest ethical standards of care and policies and procedures set forth by the Texas Department of State of Health Services and the Joint Commission. 

• CLEARFORK ACADEMY ensures all clients are treated with compassion, respect, and dignity regardless of race, creed, age, sex, handicaps, or sexual orientation. 
• CLEARFORK ACADEMY employees are competent and responsible personnel who adhere to a strict code of professional ethics which include but are not limited to the prohibition of fraternization with patients, exploitation of clients, or any criminal behaviors. 
• CLEARFORK ACADEMY provides clients with accurate and complete information regarding the available services including the program rules, regulations, goals, and objectives of the program. 
• Appropriate availability of alternative treatment modalities is made at any time before during or after treatment if they are requested or the client’s needs are out of the scope of our practice. 
• CLEARFORK ACADEMY will ensure that discharge from treatment is conducted in accordance with Texas rule standards. 
• CLEARFORK ACADEMY provides both Texas and Joint Commission environment of care standards.  
• CLEARFORK ACADEMY will take all necessary and appropriate measures to maintain individual client records and information in a confidential and professional manner. 
• CLEARFORK ACADEMY strives to maintain positive relations with the surrounding community and pursues every reasonable action to encourage responsible client behaviors and community safety.  

SUMMARY 

The Revenue & Billing Manager at CLEARFORK ACADEMY is responsible for the design, implementation, and execution of the entire billing process beginning with verification of benefits and ending with payment collection and claim close out. The Revenue & Billing Manager generates revenue for Clearfork Academy by making payment arrangements. This is accomplished through collecting accounts, monitoring, and pursuing delinquent accounts as well as completing claim follow up and dispute resolution with insurance companies on both an in-network and out of network basis, as well as with private pay clients. This position requires the ability to produce and present financial billing reports at regular intervals. 

AGE/PATIENT POPULATION(S) SERVED 

Age of Patient Population Served:  Adolescent and Young Adult Males & Females  

Population Served:  Persons meeting DSM 5 criteria for substance use disorders with or without co-occurring psychiatric illness. 

ESSENTIAL DUTIES AND RESPONSIBILITIES 

• Protects facilities’ value by keeping collection information confidential and maintaining patient confidentiality. (HIPPA Compliant & Trained) 
• Confirms eligibility and benefits verifications for treatment at all facilities. 
• Inputs the correct billing codes for services rendered and uses those codes to bill insurance providers. 
• Preparing, reviewing, and transmitting claims using electronic billing software. 
• Identifies and bills secondary and tertiary insurances for eligible clients. 
• Follows up on unpaid claims within standard 60-day billing cycle timeframe. 
• Analyzes Explanation of Benefits (EOB) forms to ensure insurance companies have paid correctly for billed charges. 
• Review client bills for accuracy and completeness and obtaining any missing information. 
• Calls insurance companies regarding any discrepancy in payments if necessary. 
• Research and appeal denied claims. 
• Collects delinquent accounts by establishing payment arrangements with clients; monitoring payments; following up with clients when payment lapses occur. 
• Utilizes collection agencies and small claims court to collect accounts by evaluating and selecting collection agencies; determining appropriateness of pursuing legal remedies; testifying for the facility in court cases. 
• Reviews accounts for insurance or patient follow-up. 
• Answers all client or