Titus Regional Medical Center
Director Revenue Cycle - Full Time
Titus Regional Medical Center, Mount Pleasant, Texas, United States, 75455
Job: Director of Revenue CycleClassification: Exempt/Salaried
Job Summary:The Director of Revenue Cycle (“Director”) is accountable and responsible for the overall leadership of revenue cycle services. This position requires in-depth knowledge of Patient Financial Services including, but not limited to, admissions, billing, medical records, charge master, credit and collections, and implementation and management of third party payer contracts. Also, studies and evaluates patient financial services procedures to improve methods of ensuring efficient claims processing, prompt collections, reducing costs of associated operations, and expediting workflow. This position works in cooperation with the CFO in creating and implementing strategies to optimize revenue.
This role requires current, in-depth knowledge of governmental and commercial insurance rules and regulations, including regulatory compliance requirements applicable to hospital and physician group revenue cycle that has both provider-based and physician office site of service components. The Director is accountable for ensuring the coordination of revenue cycle operations, procedures, and best practices for provider insurance credentialing, charge capture, billing, payment posting, collections and follow up, denials management, billing audits, and revenue cycle data reporting throughout the organization.
Essential Functions:
Evaluating the effectiveness of revenue cycle services, including charge capture, billing, collections, data reporting, and implementing changes to policies, procedures and systems, as appropriate.
The Director will identify how best to use system-wide resources encompassing the Single Billing Office, Patient Access, Referrals and Authorizations, Education & Training, and Health Information Management/Coding with the goal of optimizing reimbursement and maintaining compliance.
Implement reporting tools and key performance indicator (KPI) dashboards that monitor billing and collections performance and the effectiveness of the revenue cycle function.
Review, monitor, and assist in the explanation of performance against budget and benchmarks.
Manage, monitor and evaluate all third-party relationships related to revenue cycle.
Providing the analysis, reporting, recommendations and implementing strategic action plans for revenue cycle services performance in key metrics related to charge capture, billing, collections and accounts receivable management, such as volumes, collection ratios, A/R aging, charge lag, and related trends to the CFO and practice management staff.
Setting budgetary guidelines and making spending and resource decisions within those guidelines, ensuring accountability to operating and capital budget.
Creating a department wide understanding of the regulatory issues affecting Revenue Cycle, provider documentation and coding and maintaining compliant policies and procedures.
Assesses and responds to current and future internal and external healthcare trends to establish and ensure the necessary direction for revenue cycle activities.
Continually seeks ways and means for improving the delivery and support of revenue cycle activities and programs including monitoring the routine development of training material and ensuring educational resources to current and future staff.
Assures satisfaction among administration and providers with the quality and amount of support and data provided by monitoring and responding appropriately to outcomes and feedback while fostering a positive patient experience.
Understands the job functions of all Revenue Cycle staff, is aware of process flow across departments, and involves them, as appropriate, when recommended actions may impact their work functions.
Demonstrates good judgment in making decisions (timing, involvement of others, information presented, impact on others and operations) and is resolute in making a decision to act.
Leads efforts in monitoring and researching of regulatory changes and proposes actions to respond to changing legislation/regulations.
Monitors the payments of third party payers for the purpose of assessing compliance with established contracts.
Develops policies and procedures for all point of the revenue cycle including, but not limited to, charge capture, data entry, payment posting, insurance follow up, collections and denials management.
Reviews and updates the charge master, adjustment and denial codes as necessary. Identifies trends and accordingly makes appropriate recommendations.
Holds regular revenue cycle meetings with departmental supervisors and keeps them abreast of important issues related to revenue cycle operations.
Develops and maintains relationships with major payers.
Collaborates with clinical, financial, and managed care teams to support pay-for-performance and value-based care incentive programs.
Acts as a liaison in dealing with departmental supervisors and hospital staff. Acts as a resource to assist departments in revenue cycle performance.
Develops and implements evaluation tools and measures staff efficiency and effectiveness.
Researches department, payer, provider and other specific issues associated with revenue cycle performance.
Works with staff from Information Systems to ensure system integrity.
Responsible for coordinating physician enrollment team. Continually seeks out opportunities to improve, including automated solutions.
Discusses performance data with senior management, department supervisors, and others as necessary.
Keeps abreast of industry regulations, standards, trends and technologies.
Troubleshoots problems associated with missed or unbilled charges, payment delays, denials, and other revenue cycle issues.
Performs other duties assigned.
Follows and adheres to TRMC vaccine policy(s) mandated by the Centers for Medicare & Medicaid Services (CMS).
Work Experience:
Excellent communication and collaboration skills across a range of stakeholders.
Minimum 7 years of revenue cycle experience.
Experience with practice management systems.
Knowledge of Managed Care, Third Party Payer, and Medicare Regulations.
Prior experience leading various areas of revenue cycle (charge capture, coding, billing, collections, denials, etc.) with proven success in achieving revenue cycle efficiencies and improving cash flow.
Experience with data analysis in the healthcare industry.
Experience working closely and communicating directly with physicians, and executives.
Must have the ability to handle multiple tasks and work with various tight deadlines.
Strong communication skills.
Demonstrated interpersonal skills to work with physicians, patients, and staff at all levels, must have the ability to relate to people in a manner to win confidence and establish rapport.
Education:
A bachelor’s degree in business, health care administration or related field is preferred.
Physical Demands and Work Environment:Lifting/Carrying Pushing/Pulling
Lbs. % Time Lbs. % Time
1-10 34-66 1-10 34-66
11-20 01-33 11-20 01-33
21-50 01-33 21-50 01-33
51-75 01-33 51-75 01-33
76-100 01-33 76-100 01-33
Movement % Time
Bend/Stoop/Twist 1-33
Crouch/Squat 1-33
Kneel/Crawl 1-33
Reach above Shoulder 1-33
Reach below Shoulder 1-33
Repetitive Arm None
Repetitive Hand 1-33
Grasping 1-33
Squeezing 1-33
Climb Stairs None
Walking Uneven 1-33
Walking Even 34-66
Environment % Time
Indoors 67-100
Outdoors 1-33
Extreme Heat None
Dusty None
Excessive Noise 1-33
Equipment % Time
Motor Vehicles None
Foot Pedals None
Extreme Heat None
Dusty None
Excessive Noise 1-33
Work near % Time
Machinery None
Electricity None
Sharps 0-33
Chemicals 0-33
Fumes 0-33
Heights None
Vision
Depth Perception Required
Color Not Required
Peripheral Required
Endurance Hours at Once Total in 12HR
Sit 1 3
Stand 4 4.5
Walk 4 4.5
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Job Summary:The Director of Revenue Cycle (“Director”) is accountable and responsible for the overall leadership of revenue cycle services. This position requires in-depth knowledge of Patient Financial Services including, but not limited to, admissions, billing, medical records, charge master, credit and collections, and implementation and management of third party payer contracts. Also, studies and evaluates patient financial services procedures to improve methods of ensuring efficient claims processing, prompt collections, reducing costs of associated operations, and expediting workflow. This position works in cooperation with the CFO in creating and implementing strategies to optimize revenue.
This role requires current, in-depth knowledge of governmental and commercial insurance rules and regulations, including regulatory compliance requirements applicable to hospital and physician group revenue cycle that has both provider-based and physician office site of service components. The Director is accountable for ensuring the coordination of revenue cycle operations, procedures, and best practices for provider insurance credentialing, charge capture, billing, payment posting, collections and follow up, denials management, billing audits, and revenue cycle data reporting throughout the organization.
Essential Functions:
Evaluating the effectiveness of revenue cycle services, including charge capture, billing, collections, data reporting, and implementing changes to policies, procedures and systems, as appropriate.
The Director will identify how best to use system-wide resources encompassing the Single Billing Office, Patient Access, Referrals and Authorizations, Education & Training, and Health Information Management/Coding with the goal of optimizing reimbursement and maintaining compliance.
Implement reporting tools and key performance indicator (KPI) dashboards that monitor billing and collections performance and the effectiveness of the revenue cycle function.
Review, monitor, and assist in the explanation of performance against budget and benchmarks.
Manage, monitor and evaluate all third-party relationships related to revenue cycle.
Providing the analysis, reporting, recommendations and implementing strategic action plans for revenue cycle services performance in key metrics related to charge capture, billing, collections and accounts receivable management, such as volumes, collection ratios, A/R aging, charge lag, and related trends to the CFO and practice management staff.
Setting budgetary guidelines and making spending and resource decisions within those guidelines, ensuring accountability to operating and capital budget.
Creating a department wide understanding of the regulatory issues affecting Revenue Cycle, provider documentation and coding and maintaining compliant policies and procedures.
Assesses and responds to current and future internal and external healthcare trends to establish and ensure the necessary direction for revenue cycle activities.
Continually seeks ways and means for improving the delivery and support of revenue cycle activities and programs including monitoring the routine development of training material and ensuring educational resources to current and future staff.
Assures satisfaction among administration and providers with the quality and amount of support and data provided by monitoring and responding appropriately to outcomes and feedback while fostering a positive patient experience.
Understands the job functions of all Revenue Cycle staff, is aware of process flow across departments, and involves them, as appropriate, when recommended actions may impact their work functions.
Demonstrates good judgment in making decisions (timing, involvement of others, information presented, impact on others and operations) and is resolute in making a decision to act.
Leads efforts in monitoring and researching of regulatory changes and proposes actions to respond to changing legislation/regulations.
Monitors the payments of third party payers for the purpose of assessing compliance with established contracts.
Develops policies and procedures for all point of the revenue cycle including, but not limited to, charge capture, data entry, payment posting, insurance follow up, collections and denials management.
Reviews and updates the charge master, adjustment and denial codes as necessary. Identifies trends and accordingly makes appropriate recommendations.
Holds regular revenue cycle meetings with departmental supervisors and keeps them abreast of important issues related to revenue cycle operations.
Develops and maintains relationships with major payers.
Collaborates with clinical, financial, and managed care teams to support pay-for-performance and value-based care incentive programs.
Acts as a liaison in dealing with departmental supervisors and hospital staff. Acts as a resource to assist departments in revenue cycle performance.
Develops and implements evaluation tools and measures staff efficiency and effectiveness.
Researches department, payer, provider and other specific issues associated with revenue cycle performance.
Works with staff from Information Systems to ensure system integrity.
Responsible for coordinating physician enrollment team. Continually seeks out opportunities to improve, including automated solutions.
Discusses performance data with senior management, department supervisors, and others as necessary.
Keeps abreast of industry regulations, standards, trends and technologies.
Troubleshoots problems associated with missed or unbilled charges, payment delays, denials, and other revenue cycle issues.
Performs other duties assigned.
Follows and adheres to TRMC vaccine policy(s) mandated by the Centers for Medicare & Medicaid Services (CMS).
Work Experience:
Excellent communication and collaboration skills across a range of stakeholders.
Minimum 7 years of revenue cycle experience.
Experience with practice management systems.
Knowledge of Managed Care, Third Party Payer, and Medicare Regulations.
Prior experience leading various areas of revenue cycle (charge capture, coding, billing, collections, denials, etc.) with proven success in achieving revenue cycle efficiencies and improving cash flow.
Experience with data analysis in the healthcare industry.
Experience working closely and communicating directly with physicians, and executives.
Must have the ability to handle multiple tasks and work with various tight deadlines.
Strong communication skills.
Demonstrated interpersonal skills to work with physicians, patients, and staff at all levels, must have the ability to relate to people in a manner to win confidence and establish rapport.
Education:
A bachelor’s degree in business, health care administration or related field is preferred.
Physical Demands and Work Environment:Lifting/Carrying Pushing/Pulling
Lbs. % Time Lbs. % Time
1-10 34-66 1-10 34-66
11-20 01-33 11-20 01-33
21-50 01-33 21-50 01-33
51-75 01-33 51-75 01-33
76-100 01-33 76-100 01-33
Movement % Time
Bend/Stoop/Twist 1-33
Crouch/Squat 1-33
Kneel/Crawl 1-33
Reach above Shoulder 1-33
Reach below Shoulder 1-33
Repetitive Arm None
Repetitive Hand 1-33
Grasping 1-33
Squeezing 1-33
Climb Stairs None
Walking Uneven 1-33
Walking Even 34-66
Environment % Time
Indoors 67-100
Outdoors 1-33
Extreme Heat None
Dusty None
Excessive Noise 1-33
Equipment % Time
Motor Vehicles None
Foot Pedals None
Extreme Heat None
Dusty None
Excessive Noise 1-33
Work near % Time
Machinery None
Electricity None
Sharps 0-33
Chemicals 0-33
Fumes 0-33
Heights None
Vision
Depth Perception Required
Color Not Required
Peripheral Required
Endurance Hours at Once Total in 12HR
Sit 1 3
Stand 4 4.5
Walk 4 4.5
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