Director of Revenue Cycle

Essential Job Functions

• Directs the operations of the coding, billing department, payment posting, accounts receivable follow-up, and reimbursement management.
• Responsible for the management and direction of the coding, billing, workers’ compensation, medical records and disability department personnel, which includes work allocation, training, and problem resolution; evaluates performance, and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
• Works collaboratively with the COO, Billing Manager, Billing Coordinator and Coding Coordinator to provide direction and oversight to help improve operations, decrease turnaround times, streamline work processes, and work cooperatively to provide quality customer service.
• Ensures KPIs are meeting industry standards for optimizing performance of the departments.
• Manages customer accounts and inquiries.
• Provides regular education to the coders, billers, business office staff and the providers.
• Maximize revenue through the accurate and complete capture of all charges.
• Identifies and resolves problems that are impacting revenue cycle.
• Captures and manages effective and timely denial management and appeals.
• Maintains current knowledge regarding payer requirements, polices, ensures system updates are completed accordingly and keeps team informed and updated regarding changes and requirements.
• Ensures accurate and timely month end close process.
• Conducts internal reviews of claim workflow for process improvement and compliance monitoring.
• Manages revenue cycle projects.
• Makes decisions and recommendations on HR issues affecting assigned staff, including hiring, promotion, discipline, attendance, compensation, and termination. Conducts new hire training and continuing education. Provides a consistent training program.
• Attends management meetings and assists with training, and implementation of improvements based on audit results.
• Ensures that the activities of the departments are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.
• Captures and coordinates any internal and external audit process of billing practices.
• Ensures compliance with HIPAA, OSHA and safety compliance.

Education & Experience

• High School Diploma or equivalent.
• Associates degree, preferably in coding/billing, business administration, or related field is preferred.
• Certified Professional Coder through AAPC is preferred.
• Management experience in medical billing (5) five years and minimum of seven (7) seven years of medical billing experience is required.
• EPIC experience is required.
• Previous orthopaedic and/or surgical practice experience is preferred.

Other Requirements

• Schedules will change as department needs change including overtime, evenings and weekends.
• Travel as needed.

Performance Requirements

• Knowledge:
  • Knowledge of OrthoCincy’s Mission, Vision and Values.
  • Knowledge of billing, coding and clinic rules, guidelines, compliance, and operating policies.
  • Knowledge of anatomy and medical terminology.
  • Knowledge of and stays currents on all billing and coding guidelines/updates.
  • Knowledge of billing practices and clinic policies and procedures.
  • Knowledge of electronic health records and practice management systems.
  • Knowledge of HIPAA guidelines.
• Skills:
  • Excellent organizational, multi-tasking and adaptability skills.
  • Detail oriented.
  • Basic math skills.
• Abilities:
  • Ability to understand and interpret policies and procedures.
  • Ability to communicate and educate staff and medical providers.
  • Ability to read and interpret medical charts.
  • Ability to examine documents for accuracy and completeness.
  • Ability to maintain productivity set forth by leadership, while ensuring accuracy.
  • Ability to communicate effectively with all ages and work well with others.
  • Ability to maintain a 93% accuracy rate.