Provides leadership, oversight, and subject matter expertise to enhance and maintain a properly functioning organization-wide revenue cycle process that contributes to the capture, management, and collection of patient services revenue.

DUTIES AND RESPONSIBILITIES:

1. Formulates objectives, policies and procedures related to all related revenue cycle activities within the organization and communicates these policies and procedures to appropriate staff for execution. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers. Maintains current knowledge of all changes and proposed changes by federal and state regulators, particularly Medicare and Medicaid, as they relate to billing and coverage changes. Provides the final decision on billing issues when disputes arise.

2. Plans, manages and completes regular and special projects associated with revenue cycle improvement. Must analyze payer trends, internal revenue cycle reports, productivity measures, case mix trends, and denial trends to identify and affect appropriate change to maximize reimbursement. Maintains appropriate internal control safeguards over AR records and collection of cash. Assesses and responds to organizational and member needs with innovative programs to ensure member satisfaction. Implement member friendly billing guidelines.

3. Ensures that billing and receivables are processed in an accurate and timely manner; that timetables are maintained relative to billing, mitigate write offs, payment/denial posting, month-end closing, and produces monthly reports for management review. Analyzes cash collections to identify underperforming payers and prioritize claims most likely to pay. Develops and maintains relationships with payers to ensure prompt resolution of payment issues.

4. Provides initial and ongoing education to all departments on Revenue Cycle initiatives as they are identified. Directs ongoing programs for staff development to include establishing multi-disciplinary revenue cycle teams to assist in enhancement of both quality and efficiency.

5. Participates, in concert with Human Resources, the recruitment, interviewing, hiring, and disciplinary actions of business office staff. Completes annual and periodic performance evaluations of business office staff.

6. Presents to others in writing, via telephone or directly in a personal and professional manner. Obtains a 4.5 rating or above in the inter-department service survey. Obtains a 3.5 overall rating in quarterly leadership empowerment survey.

7. Recommends operating and capital budgets and monitors allocation of resources. Work with other executives as required, including systems evaluation and upgrades, cash forecasting, billing and collection data, statistical information, monthly revenue and receivables aging, periodic Medicare cost reporting, cash delinquencies and schedules.

8. Advocates for the Center and serves as liaison to local and state professional societies, as well as to local and state officials, organizations, and third-party payers, as appropriate.

9. Performs other related duties as assigned.

JOB QUALIFICATIONS:

Bachelor's degree from an accredited college or ten years of proven, progressive experience in healthcare revenue cycle management, which includes five years of management experience; Master's degree preferred.

Knowledge of Health Resources Service Administration and Texas State insurance regulations relating to healthcare billing and collections including medical, dental, behavioral health, and specialties, and value-based and managed care contracting;

Background in operating practice management system software, including table set-up and maintenance

Familiarity with clinician credentialing rules, PPS payment model, ICD-9-CM and ICD-10-CM and CPT coding; familiarity with medical terminology,

Ability to work with Microsoft Office; experienced use of Excel

Knowledge of integrating artificial intelligence, automation, and/or robotics into revenue cycle process

Scheduled hours and/or work locations are subject to change

PHYSICAL ACTIVITIES AND REQUIREMENTS:

Finger Dexterity: Using fingers to make small movements such as typing or picking up small objects.

Talking: Frequently conveying detailed or important instructions or ideas accurately, clearly, or quickly.

Hearing: Able to hear average or normal conversations and receive ordinary information.

Repetitive Motions: Frequently and regularly using the wrists, hands, and fingers.

Visual: Average, ordinary, visual acuity necessary to prepare or inspect documents or other materials.

Physical: Limited physical effort required; May have to lift folders, files, papers, audio/video equipment, and other such items weighing up to approximately 25 lbs.