E00934 – Director, Revenue Cycle Analytics
Works closely with internal and external stakeholders across functional units on all revenue cycle topics including insurance verification, charge capture, coding/billing, edit/denial management, A/R follow-up, cash applications, refunds, and self-pay management. The Revenue Cycle Director (RCD), reporting to the VP of Patient Accounts, will have primary responsibility to drive cash flow performance and meet/exceed financial targets for the revenue cycle. The RCD will be articulate, analytical, and a team player who understands the power of data in healthcare. The revenue cycle manager must enjoy coordinating with interdisciplinary teams, learns quickly, and works independently. Generates accurate reports, compiles data, and reports to support revenue cycle workflows to assist with timely and accurate charge capture, billing, and collection of receivables. Reports are generated on a prescribed periodic basis (daily, weekly, etc.) Serves as the owner for compliant CDM implementation and maintenance. Works with Operations, Billing, IT and Managed Care to ensure maintenance of data according to regulations and payer requirements. The Revenue Cycle Director will be expected to be a resource for the entire Revenue Cycle and its operations. Works with other departments for the activation, deactivation, deletions, and additions of codes. Performs quarterly updates for coding initiatives. Excellent written and communication skills with the ability to write, present, and explain recommended materials in a clear, concise, and organized format.
- Designs/utilizes a variety of reports to identify issues within the Revenue Cycle process to meet/exceed cash collection goals.
- Identifies improvement opportunities and documents work-flow processes and procedures.
- Collaborates with the operations team to ensure site work-flow processes are aligned to ensure billing compliance and accuracy.
- Enter financial reclasses as needed to support billing team and track/trend root causes to reduce volume.
- Acts as liaison between managed care, billing, and IT to ensure contract information is accurately loaded in Avatar with payer contracted rates.
- Completes Avatar IT requests for new payer guarantors, guarantor changes/updates, 837/835 changes and other billing changes as needed.
- Track and trend OON payer reimbursements based on guarantor and group plans identifying low paying guarantors/groups and communicating to all applicable parties.
- Works and manages the unbilled report to resolve unbilled items and distributes follow-up items to other departments and reconciling feedback to ensure all unbilled dollars are billed timely according to third-party requirements.
- Performs weekly/monthly reconciliations of patient balances with third-party collection agencies to ensure accurate patient balances and refers new accounts based on established parameters.
- Assists A/R team with monitoring and working high dollar accounts for expediate reimbursement.
- Manages administrative appeals and tracks/trends payer issues reporting them to managed care team.
- Identifies, investigates, and resolves under/overpayments across payers and financial classes according to established company contracts.
- Manages edits in claims scrubber based on payer requirements to improve the clean claim rate
- Maintains RCM dashboard with defined KPI metrics and provides recommendations for process improvements to surpass KPI goals.
- Participates in developing staff education materials aimed at improving the quality of insurance verification and authorization.
- Provides support to The Patient Accounts team and each of its subgroups to track productivity, quality, staffing patterns, expenses, and efficiency metrics.
- Builds relationships with key stakeholders, be an expert in multiple data sources, and creates/implements innovative and sustainable solutions for the measurement of RCM processes.
- When appropriate, provides communication and relationship building with payers and third-party contractors to make improvements in the revenue cycle.
- Leads Process Improvement initiatives- committees when needed.
- Produces all Bad Debt Adjustment and Denial Management Reporting and is an integral member of the A/R Team.
- Attends and actively participates in designated RCM standing meetings, including summarizing, and distributing meeting minutes.
- Supports Executive and Operations Teams with report requests on an ad-hoc basis.
- Performs other duties and special projects as assigned.
Education and Experience:
- Bachelor’s degree in business, healthcare administration, accounting, finance, or a related field is preferred, or equivalent combination of education, training, and experience.
- 2 to 4 years of supervisory and/or data reporting and analysis experience in healthcare billing, accounts receivable, financial management, accounting or a directly related field is required.
- Advanced knowledge of MS Word, Excel, Access, Outlook, and PowerPoint.
- Working knowledge of SQL Reporting.
- Experience building and maintaining database in Quick books.
- Excellent oral and written communication skills, along with the ability to communicate and negotiate with a variety of internal and external constituencies.
- Strong managerial, planning, organizational, decision-making, interpersonal, analytical, and lateral thinking skills.
Customer Service: Demonstrates concern for meeting internal and external customers’ needs in a manner that provides satisfaction for the customer within the resources that can be made available.
Integrity: Upholds personal and professional ethics and values, considering the values of RCA and respecting the culture, beliefs, and abilities of individuals.
Ability to effectively deal with difficult people: the ability to respond to difficult customer behavior with diplomacy and tact including defusing anger, creating rapport an influencing behavior.
Work Environment: May work in a variety of environments including professional offices, clinics, hospitals, or out-patient facilities. They spend much of their time on their feet, actively working with patients.
Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus.
Travel: Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected