Position Summary: The Director of Revenue Cycle is responsible for overseeing all financial aspects of the revenue cycle for OP Specialty Bracing clinics. This includes managing patient access, billing, coding, collections, and compliance. The director leads and mentors a team to optimize financial performance, reduce claim denials, and ensure adherence to all federal, state, and payer-specific regulations, including those from Medicare, Medicaid, and private insurers.
Responsibilities: - Strategic leadership and financial management:
- Develop and implement revenue cycle strategies to enhance operational efficiency, maximize cash flow, and achieve financial goals.
- Analyze revenue cycle key performance indicators (KPIs), such as days in accounts receivable (A/R), denial rates, and collection efficiency, and present reports to division leadership.
- Create and manage the revenue cycle budget, justifying variances and conducting cost-benefit analyses for new resource investment.
- Evaluate and implement revenue cycle technologies, including electronic medical records (EMR) and billing software, to automate and streamline workflows.
- Billing and coding operations:
- Oversee the entire billing process, from charge capture and claims submission to payment posting.
- Ensure that all billing and coding practices align with current orthotic & prosthetic (O&P)-specific L-code and ICD-10 coding standards.
- Supervise the team responsible for managing and resolving claims, including rejected or denied bills.
- Stay up-to-date on changes in reimbursement rates, regulations, and billing requirements from all third-party payers.
Compliance and risk management: - Ensure strict compliance with all federal, state, and local regulations, including HIPAA, Medicare, and Medicaid rules.
- Maintain extensive knowledge of regulatory requirements for government and managed care payers as they apply to O&P.
- Lead internal and external audits and develop corrective action plans for compliance deficiencies.
- Oversee the management of medical records and patient documentation to support accurate billing.
Team leadership and development: - Lead, mentor, and evaluate the revenue cycle team, including contract, authorization, and billing specialists.
- Provide training and continuing education to clinical and administrative staff on proper coding, documentation, and revenue cycle procedures.
- Promote a collaborative, team-oriented environment both within the department and with other clinical and operational departments.
- Perform other duties as needed.
Qualifications and Skills: - Bachelor's degree in a related field (master's often preferred) and 7-10 years of progressive healthcare revenue cycle experience, with at least 3 years in leadership.
- O&P-specific experience is highly desirable.
- Relevant certifications are beneficial.
- Necessary skills include expertise in medical billing, coding, and reimbursement, familiarity with relevant software (preferably Nymbl and Waystar), strong analytical, problem-solving, leadership, communication, and interpersonal skills, and knowledge of payer relations and contracts.
*This job description is not intended to be and should not be construed as an all-inclusive list of all the responsibilities and working conditions of the position. While it is intended to accurately reflect the position of activities and requirements, management reserves the right to modify, add or remove duties and assign other duties as necessary
Benefits Offered for Eligible Employees: - Medical Insurance
- Dental Insurance
- Vision Insurance
- Long & Short-Term Disability
- Life Insurance and AD&D
- Retirement Savings Plan
- Paid Time Off (PTO) & Holidays
The pay range for this role is:
110,000 - 150,000 USD per year (Remote)
