Assoc. Director Revenue Optimization

POSITION SUMMARY

Supports the VP of Revenue Cycle Operations and Optimization in managing aspects of revenue cycle optimization, including maintaining relationship and monitoring of third-party billing organization and EPIC hosting organization, identifying and implementing revenue optimization strategies, regulatory compliance with third-party insurers (Medicaid, Blue Cross/Blue Shield, etc.), and maintenance of billing and reporting systems. Supports fee schedule, contract review and credentialing activities for managed care contracts.

• Recruits, retains and develops a diverse and highly qualified staff; provides ongoing performance feedback and maintains a safe and professional work environment.
• Trains or assists in training staff in other departments on revenue cycle related areas (both administrative and program) as needed.
• Evaluates staff in a timely manner in accordance with PPGNY’s policies.
• Performs other training and mentoring related duties as required.

• Performs analysis of revenue cycle trends and identifies areas of focus to reduce denials and increase overall collections.
• Performs root cause analysis for areas identified, proposes solutions to achieve overall enhancement of revenue and implements changes.
• Develops workplans to address billing corrections needed, works closely with EPIC hosting organization to implement automated solutions.
• Collaborates with third party RCM vendor and health center operations to implement process changes.
• Collaborates with cross functional teams to ensure alignment between clinical operations and PPGNY billing practices.
• Tracks adherence to process changes implemented and quantify financial impact.
• Monitor health centers’ adherence to charge reconciliation processes and metrics measured by key performance indicators and work with HC leadership to address issues/ trends identified.
• Ensure changes within the charge description master (CDM) coincide and are implemented with clinical systems.
• Review changes in CPT®, HCPCS, and revenue codes for accuracy, compliance with applicable billing guidelines, and optimization of reimbursement.
• Develop, deliver, and revise integrity education and training programs in coordination with clinical operations and leadership.
• Perform revenue integrity reviews and present findings for corrective actions.

• Develops and implements reporting tools to identify revenue cycle trends, including root cause of denials.
• Builds reporting tools to monitor productivity and quality of work performed by staff that impacts RCM results, including front desk, financial counselors, and third-party RCM vendor.
• Creates reports to monitor the impact of RCM enhancements and ensure compliance with new processes.
• Works closely with Data Analytics team to develop dashboards, scorecards and other tools to monitor performance.

• Evaluates the results of the periodic coding audits conducted by an outside agency, and partners with the VP of Revenue Cycle Operations and optimization and clinical services leadership to provide training and feedback to the clinical providers on their performance and areas for improvement.
• Actively maintains an up-to-date knowledge base of developments in third-party billing, such as changes in Medicaid reporting requirements. Identifies changes required to department procedures in response to such developments.
• Responsible for identification of training needs for all registration areas and provide training material working in conjunction with RDO of operations.
• Maintain up to date knowledge of CMS billing rules and payer requirements to proactively identify policy changes.
• Remain current on payer billing requirements.
• Remain current on Epic reporting tools.

• A demonstrated commitment to PPGNY’s mission related to bodily autonomy, health equity, gender and racial justice.
• A demonstrated commitment to learning about and enhancing practices related to racial equity and its impact on healthcare systems.
• Strong relationship building and communication skills, including an…