Director of Revenue Cycle

About the role

The Revenue Cycle Director oversees and manages the full revenue cycle, ensuring maximum revenue capture and compliance with all regulations and insurance policies. The Director works closely with the Senior Director of Operations and other members of the Executive Team to support strategic planning, transparent communication, and staff training related to the revenue cycle and collections.

Responsibilities

• Works closely with the Senior Director of Operations and other members of the Executive Team to support strategic planning, transparent communication, and staff training related to the revenue cycle and collections.
• Is the main point of contact and vendor relationship manager for OCHS’ contracted billing company, which performs pre-registration, billing and credentialing services.
• Serves as the liaison between the outside vendor and the key leaders and stakeholders within OCHS who oversee or participate in portions of the revenue cycle.
• Oversees the Healthy Connections Team, which provides insurance enrollment assistance to patients and community members.
• Ensures proper and up-to-date provider credentialing and rostering with payers including commercial insurance, Medicaid and Medicare.
• Communicate timely with clinical and operational leaders on the status of new providers and any changes of status for existing providers.
• Works closely with clinical leadership to ensure providers are properly documenting and billing all services rendered.
• Collaborates on required training/education for providers and serves as internal contact for questions related to billing and clinical documentation.
• Works closely with operational leadership to ensure the front-end staff have the required standard operating procedures, scripts and forms to effectively verify, capture and communicate all required information and referrals/authorizations ahead of a visit.
• Collaborates on required training/education for front line staff and serves as internal contact for questions related to the front-end portion of the revenue cycle.
• Works closely with the finance leadership to research and support financial issues such as unapplied payments and patient refund requests.
• Serves as the main point of contact within OCHS for any patient questions or complaints related to charges or a bill.
• In collaboration with the contracted billing company and OCHS’ internal EMR Team, maintains the charge master, reviewing and updating as needed.
• Reviews all reports and invoices coming from the contracted billing company to ensure all work is being performed in a timely, accurate and compliant manner.
• As needed, prepares reports and/or executive summaries to OCHS leadership on key revenue cycle metrics.
• Affairs with assessing current processes and policies that impact revenue cycle, identifying problems or roadblocks that exist and proposing potential solutions.
• Stays informed on any regulatory, legal and billing/coding changes that go into effect that would impact revenue cycle activities and/or workflows.
• Proactively communicates new information to leadership.
• Attends webinars, trainings and workgroups related to billing and revenue cycle activities.

Qualifications

• At least 5 years of experience as a Revenue Cycle Manager or in a similar position.
• Bachelor’s degree in healthcare administration, business or finance preferred.
• At least 2 years of experience as a supervisor or manager.
• Experience managing remote staff preferred.
• Strong familiarity with medical coding and healthcare billing required; being a certified coder is a plus.
• Experience working with a federally qualified health center (FQHC) or other primary or ambulatory care organization a plus.
• Knowledge of HIPAA regulations.
• Experience with the Epic EMR a plus.
• Strong written and verbal communication skills.
• Experience communicating with diverse stakeholders (i.e. medical providers; front desk staff; patients; insurance providers; c-suite leaders, etc.).
• Experience managing a vendor’s performance and serving as a liaison between internal stakeholders and an external vendor.
• Experience interacting with patients and families, particularly related to researching and resolving questions or issues related to patient charges and bills.
• Strong analytical and problem-solving skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy.
• Ability to work within a collaborative team setting and independently.
• Proficiency in computer skills including Epic, Outlook, Microsoft Office, OneDrive, etc.
• Excellent judgment and ability to solve problems in a timely manner.
• Ability to adhere to strict confidentiality standards.
• Demonstrated ability to work in a culturally diverse and inclusive environment.