ASSISTANT DIRECTOR, REVENUE CYCLE

JOB PURPOSE:

The Assistant Director, Revenue Cycle is responsible for the management and execution of enterprise-wide (CenterLight and its associated entities including C2Q Health Solutions, and Team Care Medical) billing and revenue maximization activities, including analysis, reconciliation, and operational procedures to ensure timely and accurate billing and revenue recognition while adhering to compliance with DOH and CMS guidelines. The position oversees day-to-day operations with directly engages in outreach efforts to members and providers as critical part of the position. Additionally, it serves as liaison between Finance, Enrollment and Intake team, medical practice staff as well as other areas across the organization.

JOB RESPONSIBILITIES:

Revenue Optimization and Entitlement

• Responsible to manage and perform the end-to-end process of Revenue Optimization and Entitlement operations, overseeing member and provider outreach for Dual conversion, ESRD, and Nursing Home entitlements.
• Perform membership and claims analytics, including IBNR, MMR and 820/834 reconciliation.
• Perform reconciliation of payments received to billing files.
• Perform analytics to identify members eligible for Dual conversion, ESRD, and Nursing Home entitlements.
• Identify members with Surplus and NAMI, coordinate with members regarding surplus issues and assist with the re-budgeting process using HRA. Resolve issues related to members with Surplus, NAMI, or Pooled Trust.
• Identify LTC/Custodial Nursing Home cases and collaborate with the Clinical team and NH providers to obtain budget letters for NAMI collection.
• Conduct outreach to Nursing home members with surplus balances for collection or potential participation in pooled trust.
• Collaborate with Dialysis providers to obtain 2728 forms and update member ESRD indicators with CMS MAPD Helpdesk.
• Assist the Intake and Enrollment team with CMS related issues and work closely to resolve members entitlement issues.
• Coordinate enrollment MSP letters and address discrepancies in CMS ECRS.
• Assist in development and implementation of cost saving initiatives.
• Lead department in responding to audit inquiries, including closing the loop on any potential Corrective Action Plan (CAPs), from internal and external auditors (including CMS, NY DOH, and other government agencies) for all CenterLight and its associated entities including C2Q Health Solutions, and Team Care Medical, ensuring timely delivery of requested information.

Billing Operations

• Oversee the day-to-day operations of physicians' billing for enterprise-wide operations.
• Ensure accurate, timely, and compliant billing, coding, and collections.
• Develop and implement billing policies and procedures.
• Manage patient billing inquiries and resolve any issues.
• Coordinate with healthcare providers, practice managers, and coders to submit claims appropriately and timely.
• Audit billing and collection procedures to ensure accuracy and compliance with regulations.
• Monitor billing performance and create reports for management.
• Stay informed about current billing and coding regulations and guidelines.
• Develop strategies to improve efficiency and reduce billing errors.
• Monitor accounts receivables and work on rejections and denials.
• Perform ad-hoc analysis to support organization strategic initiatives.
• Other duties as assigned.

Management standards:

• Policies and Procedures: (1) Create Policies and Procedures needed, (2) Monitor Compliance, (3) Ensure all employees are aware of the policies, (4) Review them annually, (5) Discuss and obtain final approval of new or revised policies with the P&P committee annually.
• Manage, teach, and mentor staff. Responsible for hiring, appraising, developing, and whenever applicable, disciplining staff for performance issues.
• Collect and analyze the projects business requirements and transition knowledge to the team and other key stakeholders.
• Validate data quality, ensure business reporting needs are fulfilled, and processes are documented.
• Work with leadership to identify, define and utilize standard tools and analytical approaches
• Ensure a high level of customer service for internal and external customers.
• Keep abreast with any updates to claims payment configuration requirements from both governmental agencies (NYS DOH and CMS), including attending recurring work group meetings with both agencies.
• Support and promotion of automation and reporting tools adaption to streamline reports and analytics operations and delivery.

QUALIFICATIONS:

Education: Bachelor’s degree