Director of Revenue Cycle Management

Overview

Reporting to the VPs of National PFS & Financial Clearance, the Director of Regional Revenue Cycle will be responsible for overseeing all financial clearance and billing activities for Confluent Health, the implementation of policies and procedures, management of front-end, and back-end billing operations, and supervision of the Financial Clearance and PFS Managers. This individual directs and oversees the overall procedures, objectives, and initiatives of the organization’s revenue cycle activities to optimize the patient financial interaction along the care continuum. They will lead initiatives that review, design, and implement processes surrounding authorization, insurance verification, billing, third party payer relationships, collections and other financial analyses to ensure that clinical revenue cycle is effective and properly utilized. This individual will track and monitor numerous metrics related to the revenue cycle including record insurance verification rates and billing turnaround times to develop sound revenue cycle analysis and reporting. The Director will manage relations with payers and providers to generate high reimbursement rates and a low level of denials. The Regional Revenue Cycle Director creates functional strategies and specific objectives and develops budgets/policies/procedures to support the functional infrastructure of the Brands and Centralized Billing Offices.

Responsibilities

1. Work with senior management to maximize clinical income, maximize profitability and productivity, and ensure best practices while fully complying with all third party payer reimbursement requirements. The Director will develop performance metrics by which effectiveness, efficiencies, responsiveness and productivity is measured; ensure compliance with all applicable external regulations as well as departmental and institutional policies and procedures; and oversee revenue cycle department including, staff, systems, compliance, revenue analysis and strategic planning.
2. Oversee and support the daily operations of all FC & PFS functions, including authorization, insurance verification, billing, follow-up and collections, cash posting
3. Develop, redesign, and monitor key performance indicators including payer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other requested parameters.
4. Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks.
5. Establish a regularly scheduled revenue cycle meeting to discuss strategies and ensure everyone is educated on the direction of the department.
6. Optimize all revenue through front-end and billing and collection activities
7. Improve organization performance by identifying areas of improvement in the revenue cycle
8. Ensure all revenue cycle personnel are educated and involved in the performance of the organization;
9. Create and implement strategies to maximize revenue across the organizationAnalyze workflow and demand within the revenue cycle and set the organizational structure to meet this demand.

Qualifications

• Bachelor's degree in healthcare administration, business administration, finance or related field
• At least six (6) years of experience in the healthcare RCM industry with three (3) years in RCM Management

• Thorough knowledge of patient financial services (PFS) processes and standards related to billing, collections, and cash posting.
• Thorough knowledge of front-end processes (authorization, registration, insurance verification), finance, and data processing.

• Extensive experience leading teams and managing people
• Data analytics experience (e.g., Excel, etc.)
• Advanced communication skills and extensive experience interacting with staff, management, and executive stakeholders
• Knowledge of regulatory requirements related to patient accounting, including a solid understanding of Medicare, Medicaid and managed care processes.

• Ability to read, analyze and interpret financial reports, contracts, and other legal documents.

• Dedication to the development of others and willingness to coach and mentor people as necessary to promote their personal and professional growth

• Bachelor's degree in healthcare administration, business administration, finance or related field
• At least six (6) years of experience in the healthcare RCM industry with three (3) years in RCM Management

• Thorough knowledge of patient financial services (PFS) processes and standards related to billing, collections, and cash posting.
• Thorough knowledge of front-end processes (authorization, registration, insurance verification), finance, and data processing.

• Extensive experience leading teams and managing people
• Data analytics experience (e.g., Excel, etc.)
• Advanced communication skills and extensive experience interacting with staff, management, and executive stakeholders
• Knowledge of regulatory requirements related to patient accounting, including a solid understanding of Medicare, Medicaid and managed care processes.

• Ability to read, analyze and interpret financial reports, contracts, and other legal documents.

• Dedication to the development of others and willingness to coach and mentor people as necessary to promote their personal and professional growth

1. Work with senior management to maximize clinical income, maximize profitability and productivity, and ensure best practices while fully complying with all third party payer reimbursement requirements. The Director will develop performance metrics by which effectiveness, efficiencies, responsiveness and productivity is measured; ensure compliance with all applicable external regulations as well as departmental and institutional policies and procedures; and oversee revenue cycle department including, staff, systems, compliance, revenue analysis and strategic planning.
2. Oversee and support the daily operations of all FC & PFS functions, including authorization, insurance verification, billing, follow-up and collections, cash posting
3. Develop, redesign, and monitor key performance indicators including payer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other requested parameters.
4. Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks.
5. Establish a regularly scheduled revenue cycle meeting to discuss strategies and ensure everyone is educated on the direction of the department.
6. Optimize all revenue through front-end and billing and collection activities
7. Improve organization performance by identifying areas of improvement in the revenue cycle
8. Ensure all revenue cycle personnel are educated and involved in the performance of the organization;
9. Create and implement strategies to maximize revenue across the organizationAnalyze workflow and demand within the revenue cycle and set the organizational structure to meet this demand.