Director, Revenue Cycle Management

Overview

JOB TITLE
: DIRECTOR OF REVENUE CYCLE MANAGEMENT

GENERAL SUMMARY OF DUTIES: The Director of Revenue Cycle Management is responsible for leading RCM activities to include Billing, Collections, Revenue Integrity auditing, charge master management, medical claims management (including denials and appeals operations), cash application and other back-office functions. This position is responsible for developing and implementing strategies, processes and technologies to continuously improve and manage the revenue cycle in a fast-paced, high-volume, evolving healthcare market.

To be successful in this role, the Director of RCM will be highly capable in the following areas:

• Large data analysis and modeling capabilities in Excel & Power BI are critical.
• Demonstrated proficiency in analytical, statistical, and business intelligence tools
• Demonstrated organizational and communication skills and ability to work with detailed financial information with accuracy and confidentiality
• Demonstrated communication skills with a variety of audiences, including department management, organizational leaders, physicians, and staff members using presentations, spreadsheets, and written documents.
• Strong organizational and analytical skills
• Ability to multi-task and work both independently and within teams

Bachelor’s Degree in Healthcare Administration, Business, Finance, or related field required. Minimum of 5+ years of experience in healthcare reimbursement (RCM). In-depth knowledge of healthcare industry, payer relations, and functional compliance regulations and standards required. Previous experience managing people required. Demonstrated experience leading teams required. Strong understanding of business strategies and drivers, particularly in a sales organization.

• Runs, reviews, interprets, analyzes, and validates Revenue Cycle reports. Ensures the integrity of data provided to all areas of the revenue cycle and other areas of the organization is necessary for good decision making.
• Leads the development and implementation of revenue cycle strategies, processes and improvement initiatives to continuously improve the RCM process to maximize the Company’s billings and collections.
• Ensures the identification, analysis, and implementation of solutions designed to improve collection rates, reduce bad debt, and reduce day sales outstanding.
• Drives the design, execution, monitoring, and assessment of key RCM performance metrics to refine processes and improve efficiencies and productivity to reduce overall costs.
• Leads and manages large revenue cycle projects such as audits, budgets, and technology enhancements.
• Manages vendor relationships and works with our service provider(s) to deliver agreed-upon results, and drive cost, quality, and process improvement by establishing well-defined processes, sharing best practices, and ensuring effective working relationships.
• Assist in the management of vendor-related projects and facilitates and coordinates change management efforts.
• Delivers continuous improvements by creating RCM efficiencies through system selection/automation, process design, and avoiding waste/redundancy.
• Ensures compliance in all aspects of RCM activities including coding and billing rules and regulations by payer and state.
• Maintains knowledge of third-party payor regulations including Medicare, Medicare Advantage, Medicaid, Workers Compensation and non-governmental payers.
• Adheres to all internal Corporate Compliance guidelines, OIG, government healthcare regulations, regulatory policies and procedures, and privacy and security standards in accordance with government agencies, including HIPAA requirements.

Director of RCM must have:

• Excellent verbal and written communication skills.
• Excellent interpersonal and customer service skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Ability to deal with patients, visitors, co-workers, and physicians with courtesy and respect
• A professional outgoing warm and helpful attitude

Requires sitting and standing associated with a normal office environment; travel as business needs required.