Director of Revenue Cycle Management

SUMMARY

Under the general supervision of the Chief Financial Officer, the Director of Revenue Cycle is accountable for ensuring the coordination of all revenue cycle functions and activities with the goal of optimizing revenue. This position directs the operations of patient scheduling and registration, insurance verification, provider enrollment, clinical documentation management program(s), authorizations, patient accounting and collections, reimbursement denial management, health information management, , and charge description master file maintenance.

The Director assumes responsibility to direct, plan and supervise activities of patient registration and financial services, case management, utilization review, and health information management functions involved in following patients throughout continuum of care to ensure optimum utilization of resources, service delivery and compliance with external requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned

1. Assures revenue cycle activities are coordinated and integrated with other related departments such as patient registration, financial services, case management, utilization review, and health information management.
2. Serves as the primary contact for senior leadership, providing high-level communications and status reporting of revenue cycle metrics, initiatives, opportunities, and timely issues resolution.
3. Develops and implement standards, processes, and controls for all billing activities to ensure a timely, correct and appropriate revenue cycle process.
4. Standardizes revenue cycle reporting to include benchmarks and key performance indicators for departments reporting to revenue cycle.
5. Requests, prepares, and maintains reports on billing, coding, utilization and collection activities.
6. Monitors aged accounts and verifies appropriate collections procedures are being followed.
7. Reviews, monitors and recommends updates to the Clinic's fee schedule to maintain fees at levels that maximize reimbursement.
8. Educates management and staff on revenue cycle standards and provides timely feedback of key performance indicators.
9. Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.
10. Serves as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
11. Works with departments to develop and maintain internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implanting solutions.
12. Leads denial management initiatives, collaborating with various clinical and financial team to identify, evaluate and address patterns of rejections, root causes of payment delays and/or payer denials with focus on improving workflows, optimizing revenue collections, and reducing avoidable write-offs.
13. Manages and implements chart audit process.
14. Directs, plans and supervises activities of case managers and discharge planners in following patients throughout the continuum of care to include strategic planning and daily management of operations related to case management for all inpatient units; ensure optimum utilization of resources, service delivery and compliance with external requirements.
15. Participates in multidisciplinary team meetings regarding the planning and implementation of patient care and denials; facilitates communication and problem solving related to discharge planning.
16. Chairs the Revenue Cycle Governance Committee and directs the Charge Master and Denial Management committees. Organizes the agendas, ensures appropriate representation, and bring reports and data to support decision-making. 
17. Actively participates in the Utilization Management Committee and provides monthly statistical activity report. 
18. Maintains liaison with physicians, hospital administration and ancillary department managers to analyze unit needs, identify problems and effect change as needed to improve services.
19. Other duties may be assigned.

 COMPLIANCE RESPONSIBILITIES

• Understands and adheres to Loretto Hospital's compliance standards as they appear in the Compliance Policy, Code of Conduct and Conflict of lnterest Policy.
• Keeps abreast of all pertinent federal, state and Hospital regulations, laws, and policies as they presently exist and as they change or are modified.
• Ensures that the staff are trained and evaluated on their knowledge of and adherence to compliance policies and procedures specific to their jobs.
• Ensures all policies and procedures are documented, maintained, reviewed and approved in accordance with respective regulatory and Hospital standards.

 JOB REQUIREMENTS: 

• Bachelor's degree in Accounting or other related field required;
• Previous management or supervisory experience;
• In depth knowledge of hospital, charging and billing practices normally acquired through 5 or more years' experience in a department that performs revenue cycle functions (e.g., patient accounts, registration, coding, etc.) in order to understand revenue cycle issues.
• Working knowledge of Meditech, Epic or other similar electronic health application(s);
• Excellent communication and customer service skills;
• Excellent public speaking and presentation skills;
• Proficient in Microsoft Office applications, including strong Excel skills;
• Excellent analytical and problem-solving skills.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.

For purposes of the American with Disabilities Act, "Job Duties" are essential job functions. 

PHYSICAL DEMANDS:

While performing the duties of this job, the employee is frequently required to sit, stand and walk as well as occasionally stoop, kneel or crouch. Normal or corrected vision, hearing and ability to speak are necessary. Specific vision abilities required include close vision, sharp eye focus and ability to distinguish colors. There may be periods of stressful, intense concentration with more than average pressure used in a variety of problem solving situations.