Revenue Cycle Director directs and oversees the overall policies, objectives, and initiatives of an organization's revenue cycle activities to optimize the patient financial interaction along the care continuum. Reviews, designs, and implements processes surrounding admissions, pricing, billing, third party payer relationships, compliance, collections, and other financial analyses to ensure that clinical revenue cycle is effective and properly utilized. Being a Revenue Cycle Director tracks numerous metrics related to the patient engagement cycle including record coding error rates and billing turnaround times to develop sound revenue cycle analysis and reporting. Manages relations with payers and providers to generate high reimbursement rates and a low level of denials. Additionally, Revenue Cycle Director requires a bachelor's degree. Typically reports to top management. The Revenue Cycle Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Revenue Cycle Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)
When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Job Type:
RegularScheduled Hours:
40Work Shift:
Day (United States of America)Under the managerial oversight of the Director, Senior Manager, or Manager of Revenue Cycle, the Revenue Cycle Analyst serves as a primary point of contact for Service Line Directors, Managers, Finance Directors, clinical support staff, Physicians, allied health care providers, hospital colleagues and others regarding matters that relate to aspects of of professional and hospital revenue and other matters relating to professional and hospital revenue cycle and modality specific billing processes and/or workflows. Responsibilities are performed independently within established department policies and procedures, this position is responsible for improving revenue cycle workflow, efficiency, accuracy, reimbursement, and overall revenue control through operational and system enhancements and/or modifications. Responsible for developing an environment of customer service, continued learning and increased communication within revenue cycle and between hospital departments. Throughout the revenue cycle and across the BILH organization, the RCA will be responsible for coordinating revenue cycle policies, practices, identifying issues, trends, and provide solutions.Job Description:
Essential Duties & Responsibilities may include but not limited to:
1. Serves as revenue cycle liaison between Service Line Areas, Coding, HIM, ADT, CM, Contracting, Finance, and Revenue Cycle Leadership.
2. Responsible to advise and assist with revenue operations as they relate to Epic build decisions, in-depth analysis of denials, complex appeals, audits, credits, cash, coding, workflows, data collection, report details, claims and remittance set up, logic and processing and applicable technical issues.
3. Analyzes outstanding accounts receivable and credits and ensures that these are maintained at the levels expected by Revenue Cycle Leadership.
4. Responsible for appealing and defending claims denials, adverse audit results, and sanctions.
5. Analysis, track and trend daily, weekly, and monthly denials by payer using denial reporting tools. Maintain a system of reporting that provides timely and relevant information on all aspects of clinical appeals, audits, and compliance issues to Revenue Cycle Leadership. Develops and distributes weekly, monthly and ad hoc reports needed by Revenue Cycle Leadership and Finance.
6. Provides in depth knowledge and determines best Epic system build options and functionality that will help improve revenue cycle operational workflows and system usage and understand the choices involved in application configuration; collects and reports information to Revenue Cycle Leadership regarding potential system enhancement needs and system breaks/fix issues.
7. Analyzes work queues and other system reports and identifies denial/non-payment trends, reports and provides recommendations to the Revenue Cycle Leadership.
8. Maintains thorough knowledge of EDI claims and remittances, payer billing requirements and policies, regulatory changes in the healthcare environment. Keeps abreast of all payers and payer level professional and/or hospital coding, billing and reimbursement rules, regulations and guidelines.
9. Participates in complex projects related to denial initiatives and complex investigations into allegations of billing fraud or abuse, as necessary. Provides support for projects in which Senior Leadership is involved.
10. Conduct regular audits to ensure that LHS is coding, billing and documenting completely and accurately and are in compliance with all applicable federal and state laws and regulations.
11. Proactively identifies problems or opportunities for improvements related to clinical orders and/or clinical documentation and makes recommendations to management and/or the perspective departments with high volume/high dollar values.
12. Develop, trend, and report monthly and annual statistical reporting dashboard to coincide with departmental and organizational KPIs (Key Performance Indicator).
13. Representation at scheduled meetings with assigned payers and provider representatives to address all outstanding claims processing issues. Maintain an ongoing issues tracker for each payer in order to communicate and trend all issues and communicate with contracting any and all contracting related problems.
Minimum Qualifications:
Education:
Licensure, Certification & Registration:
Experience:
Skills, Knowledge & Abilities:
FLSA Status:
ExemptClear All
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