Director of Revenue Cycle Management

About the role

The Director of Revenue Cycle Management (Medical) position at OrthoCarolina is responsible for providing management, vision, and administrative direction to various departments within the Business Office. These departments include Accounts Receivable, Billing Support, Data Coordination, Contract Validation, Credentialing, and Customer Service.

Responsibilities

• Ensures accounts are worked in a timely manner within Accounts Receivable, maintaining low AR Days and resolving systemic issues affecting claim payment.
• Oversees surgical denials and appeals processes, working closely with Appeals Specialists to monitor and report on the appeals process and financial recovery of improperly denied claims.
• Maintains charge review edits to reduce denials, often utilizing technology to minimize these edits.
• Works with Data Coordination Manager to ensure timely posting of electronic and paper payment files, maximizing technology to reduce errors and ensure payment/adjustment integrity.
• Collaborates with bank vendors to enhance electronic efficiencies related to EFT/ERA reconciliation and 835 conversions.
• Ensures customer calls are handled promptly and accurately within Customer Service, processing Collection accounts, statement generation, and patient payment processing.
• Works with Credentialing Manager to ensure timely provider credentialing with payers to avoid denials or delayed revenue.
• Collaborates with Contract Validation Manager to identify payment variances and recover revenue due to incorrect payer processing.

Qualifications

• Bachelor of Science in health or business administration or related course of study or 7 years of healthcare management experience.
• Master’s degree preferred.
• Minimum 10 years of management in a healthcare business office setting.
• Minimum 5 years working in Epic Resolute (preferred) or comparable enterprise billing system.