Position Summary:The Associate Director of Revenue Cycle - Billing and Coding is responsible for the oversight and management of all aspects of coding and front-end billing workflows and processes. The Associate Director will define strategy, policy, production, quality assurance, best practice and play a critical role in ensuring a positive patient experience by collaborating with all internal departments, streamlining registration and patient collection processes, and implement strategies to improve operational efficiency and increase revenue from patient collections.
Essential Duties and Responsibilities:- Ensure timely and efficient medical claims billing with monitoring of medical coding, clearing house and front-end billing workflows and processes.
- Strategic planning: Develop and implement strategic plans, objectives, and initiatives for revenue cycle collections to align with the organization's goals and objectives.
- Team Management: Direct oversight, training, and monitoring of internal and external coding and billing teams with oversight of all operations, workflows, processes, and training. Coordinate and aid in the training of billing team members to collaborate and ensure goals and initiatives are sustained on identified metrics.
- Billing: Coordinate leadership and guidance with Patient Collection and Registration Team to ensure proper documentation and collection of patient demographics for correct billing and improved clean claim billed rates. Make recommendations for workflow and process improvements as needed.
- Front-end Denials Management: Ensure all clearing house denials are properly reviewed to ensure correct and timely processing of insurance claims. Track trends and identify areas of improvement and efficiency to aid in overall reduction of initially denied claims.
- EDI Management: Complete oversight and tracking of Payer portals, clearinghouse, ERA and EFT access and enrollments to streamline and improve efficiency in claims billing and payment posting. Make recommendations for process improvement and training as needed.
- Compliance: Ensure compliance with all healthcare state and federal regulations, privacy laws and billing requirements. Maintain accurate and up-to-date knowledge of industry regulations and best practices.
- Oversight of Payment Posting team to ensure all defined metrics and goals are obtained and sustained. Make recommendations for process improvement and training as needed.
- Technology and Systems: Evaluate, select, and implement claims billing systems and technologies to support efficient registration, scheduling, and data management processes.
- Collaboration: Foster effective communication and collaboration with other internal departments to optimize patient flow, coordination of care and billing of medical claims.
- Performance Metrics: Develop and monitor key performance indicators (KPIs) to assess the effectiveness and efficiency of collection services and team members and implement strategies to achieve performance targets.
- Auditing: Perform and/or oversight of daily, weekly, and monthly audits on coding and billing team members and processes to ensure production and quality assurance goals and standards are achieved and maintained. Address any variances with work plan or personal improvement plans.
- Reporting: Prepare and present weekly and monthly department reports as needed.
- Participate in performance improvement activities as necessary.
- Perform other duties as assigned.
Education and Experience:- Bachelor's degree in healthcare administration, business administration, or a related field (Master's degree preferred).
- Extensive experience in coding, front end billing, denials management, payment posting, ERA, EFT and website enrollment; preferable in a free-standing emergency room facility setting.
- In-depth knowledge of healthcare regulations, privacy laws, and billing requirements.
- Strong leadership and team management skills
- Excellent communication and interpersonal skills.
- Ability to analyze data, identify trends, and make data-driven decisions.
- Proficient in using healthcare information systems and patient access software.
- Knowledge of revenue cycle management processes and strategies.
- Proven track record in process improvement and implementing best practices.
Physical Demands:The physical demands for this position include: adequate vision, hearing, and repetitive motion. Light physical activity performing non-strenuous daily activities of an administrative nature. Ascending or descending stairs, ramps, and the like, using feet and legs and/or hands and arms. Substantial movements (motions) of the wrist, hands and/or fingers in a repetitive manner. Bending legs downward and forward by bending leg and spine.
Work Environment:Well-lighted, heated and/or air-conditioned indoor office setting with adequate ventilation.
