Description

The Revenue Cycle Director is responsible for overseeing revenue cycle management including coding, billing, collections, and denial management, and is primarily responsible for Cash Flow. The position is responsible for ensuring claims, denials, and appeals are efficiently processed, and resolving billing-related issues. The Revenue Cycle Manager will minimize bad debt, improve cash flow, and effectively manage accounts receivables. This role will also manage Provider credentialing. This position is to stay apprised of coding and revenue trends; and is responsible for coding education to clinical and coding/billing staff. In addition, this position will manage all Revenue Cycle Management staff including billers and coders.

Essential Functions:

1. Oversee and manage entire revenue cycle including billing, coding, collections, and denial management

2. Communicate professionally with various payers

3. Manage, develop, and mentor all revenue department staff, including billers and coders and RCM/Admissions Supervisor

4. Responsible for management and maintenance of billing and practice management software platform

5. Provide up to date education for clinical, billing, and coding staff on coding trends

6. Develops, evaluates, implements, and revises policies and procedures related to billing, coding, reimbursement activities and improvement strategies

7. Reconcile all receivables and revenue reports and work closely with the finance department in the development of the monthly financial statements

8. Manage and update the charge master based on the current CMS fee schedule and negotiated contracts

9. Conduct monthly analysis of Medicare/Medicaid/Third Party Payers

10. Oversees the processing of credentialing and provider enrollment applications, initial, and re-enrollment status with all Medicaid, Medicare, and Commercial Payors

11. Responsible for the generation and management of revenue, admissions, and credentialing metric reports

12. Review and resolve issues related to claim generation and rejected/denied billings

13. Commit to highest level of business and patient confidentiality possible adhering to all HIPAA and security guidelines when accessing and sharing patient information

14. Keeps abreast of all reimbursement billing procedures of third party and private insurance payers and government regulations

15. Maintains appropriate internal controls over accounts receivable, RCM process

16. Monitors accounts sent for collection and reimbursements from insurance companies and other third-party payers

17. Reviews, monitors, and evaluates third party reimbursement and research variances

18. Participates in the development of coding and billing strategies, evaluating process relative to revenue cycle, and making recommendations while ensuring compliance with any relevant rules or regulations (including HIPAA, Medicaid, Medicare, and specific 3rd Party Payors)

19. All other duties as assigned

    Requirements

Required Experience:

· A bachelor’s degree and 3-5 years of related work experience (Or equivalent experience; 15-20 years of Revenue Cycle Experience as a Director or Above).

· Knowledge of third-party payer requirements including federal, state, and private health care plans and authorization process

· Proven experience in home healthcare billing, including Medicaid/Medical Assistance

· Knowledge of basic insurance policies, procedures, and reimbursement practices with Medicare coding

· Experience supervising staff

· Prior experience with process development and execution

· Excellent communication and interpersonal skills

Preferred Experience and Qualification:

· 3 years healthcare experience at the management level

· Wellsky Experience.

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