Senior Director of Revenue Cycle

Company: CRS
Location: Las Vegas
Posted on: May 23, 2023

Job Description:

Job Summary:The Senior Director of Revenue Cycle Management reports to the CFO and is responsible for overseeing and coordinating all revenue cycle activities with a goal of maximizing reimbursement in a cost-effective manner that is in compliance with federal, state and payer-specific billing requirements. The Senior Director will oversee the overall policies, objectives, and initiatives of our healthcare facilities' revenue cycle activities to optimize the patient financial interaction along the care continuum. The Senior Director will focus activities on internal program operations and collaboration with clinical and operational leadership. The Senior Director designs a system to support the patient's financial interface across the continuum of care, using best practices of cash collection and posting, registration, insurance verification, billing, and reimbursement principles. - -Job Duties:-Oversee and support the daily operations of all PFS functions, including billing, follow-up and collections, cash posting and all Patient Access areas (Main Registration and ED Registration).-Work closely with other departments (HIM, Case Management, Information Technology, Nursing, and Ancillary departments) to streamline procedures that will help ensure correct billing to patients and payers in a timely manner, thereby expediting hospital receivables.-Oversee work schedule and direct changes in priorities and schedules as needed to assure work is completed in an efficient and timely manner and to improve the department's performance and service.-Direct the selection, supervision and evaluation of staff. Ensure performance evaluations are conducted in a timely manner according to hospital policy and initiate disciplinary actions as warranted. Resolve grievances and other sensitive personnel matters.-Oversee orientation and continuing education for all staff. Ensure mandatory and relevant training is provided to staff in a timely manner.-Implement a Quality Assurance program for PFS functions and monitor staff and team performance, making changes, when required, to support accurate billing to payers and patients in a timely manner and compliance with laws and department procedures.-Establish and maintain departmental policies and procedures. Communicate relevant information to other hospital departments. Establish controls and review mechanisms to ensure procedures are being followed correctly. Recommend policy changes to the Chief Financial Officer.-Collaborate with Billing, Collection, and Patient Access Managers to plan, organize, and deliver regular staff meetings for the department.-Assist with the development of budgets and monitoring of department operations to achieve goals within budget.-Respond personally to concerns and/or complaints expressed by patients, visitors, hospital staff, and physicians in effort to support optimal operations and excellent customer service.-Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.-Maintain appropriate internal controls for the safeguarding of cash.-Follow and monitor compliance with hospital policies and standards.-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.-Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.-Meets and exceeds short and long term goals as established for the department.-Serves as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.-Develops and maintains internal controls to target revenue recovery throughout the organizationby identifying charge capture, coding, and reimbursement problems, then recommending/implanting solutions.-Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks.-Responsible for maximizing the collection of medical services payments and reimbursements from patients, insurance carriers, financial aide, and guarantors.-In conjunction with operations, reviews and enhances insurance verification, coding review,billing, collection, and payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current work flow.-Monitors daily productions of claims, denials, and appeals.-Analyzes claims, utilization, and medical cost data.-Monitors aged accounts and verifies appropriate collections procedures are being followed.-Reviews, monitors and recommends updates to the Clinic's fee schedule to maintain fees at levels that maximize reimbursement.-Ensures compliance with relevant federal, state, and payor-specific billing requirements.-Regularly provides upper management with revenue cycle status including reports, metrics, and presentation.-Ensure staff is educated on new technology, goals, and contracts-Establish a regularly scheduled revenue cycle meeting to discuss strategies and ensure everyone is educated on the direction of the department.-Work with Managed Care vendors in identifying any payer relation issues or contracts that need to be renegotiated or negotiated for the first time.-Any and all other projects, goals, issues surrounding the revenue cycle, conflicts or concerns as directed or indicated by Administration.-Assists in evaluation of reports, decisions, and results of department in relation to established goals.-Recommends new approaches, policies, and procedures to influence continuous improvements in department's efficiency and services performed.-Actively participates in problem identification and resolution and coordinates resolutions between appropriate parties.-Adheres to Corporate, Department and HR policies and procedures. - -Education and Experience Qualifications: --Bachelor's degree in Healthcare Administration, Business, Accounting, Finance or related field and three years of management-level experience in hospital revenue cycle with expertise in billing and collections.-Knowledge of Healthcare and Family Services (HFS) regulations-General computer skills with working knowledge of word processing, spreadsheet, and email applications.-Knowledge of third-party billing related activities for Medicaid, Medicare, and Commercial Managed Care contracts-Excellent oral and written communication skills to effectively communicate with customers and all levels of management.-Seven (7) years of experience in financial management or administration for an integrated health system-Three (3) years of experience with third party billing related activities for Medicaid, Medicare and Commercial Managed Care contracts-Three (3) years of supervisory and/or managerial experience-Three (3) years of experience in a safety net or teaching hospital-Advanced proficiency In Microsoft Office Excel-Project management experience-Electronic Medical Record experience-Experience in Program or service implementation and performance improvement -Physical Requirements:-Employee is required to have visual and auditory acuity necessary for communications with other employees and/or customers to meet business needs of the organization.-Employee must be able to see written documentation and be able to speak and hear for communication with employees/customers.-Ability to use a wide array of office equipment including, but not limited to a PC, copier, fax, multi-line telephone, etc.-Employee is exposed to general indoor working conditions and may on occasion require light lifting or no greater than 20 pounds and some offsite travel.Powered by JazzHR

Keywords: CRS, Las Vegas , Senior Director of Revenue Cycle, Executive , Las Vegas, Nevada