The Director Revenue Cycle Optimization and Improvement will lead major change initiatives within the Revenue Cycle Department. The Director will have the overall responsibility for designing and implementing solutions to meet business objectives, such as application implementation and process optimization, for the revenue cycle process. This individual will develop and maintain applicable P&P and process maps, perform gap & variance analysis to identify areas for improvement, lead implementation projects, and hold departments accountable for the compliance to key processes and metrics.
Essential Duties and Responsibilities:
- Work to pro-actively identify and prioritize revenue cycle optimization and improvement opportunities with the help of the other revenue cycle leaders.
- Plan, direct and coordinate implementation of re-engineering solutions across revenue cycle departments.
- Direct revenue cycle assessments, analysis, planning, and training of process redesigns.
- Lead revenue cycle improvement activities to address organizational and customer needs with innovative programs and solutions to ensure compliance and revenue cycle efficiency.
- Assist Revenue Cycle leadership with strategic planning of major projects and identification of areas with need of performance improvement.
- Build framework to assess areas with highest need for performance improvement.
- Assess the current capabilities of IT revenue cycle systems and create and lead implementation of innovative revenue cycle IT solutions.
- Lead revenue cycle departments in the analytical components of workflow redesign.
- Calculate benefit of projects identified during strategic planning.
- Lead scope discussions to highlight ultimate project goals.
- Create project work plans to guide implementation.
- Work with company leadership to implement identified projects.
- Assume primary functions of project management to implement Revenue Cycle projects.
- Manage projects against established timelines, scope and budget.
- Monitor the performance of revenue cycle activities utilizing monitoring tool sets and performance metrics.
- Study current Revenue Cycle best practices, to ensure company leadership is aware of leading-edge technology and processes.
- Actively engage to stay on top of current industry trends and compliance requirements.
- Performs other position appropriate duties as required in a competent, professional and courteous manner.
Knowledge, Skills and Abilities:
- Project management experience with strong communication, analytical, organizational and implementation skills
- Excellent business writing skills to include the development of written policies and procedures
- Strong collaboration and persuasion skills to coordinate work efforts across multiple departments
- Ability to work and coordinate workforces across multiple geographic locations
- Proven ability to execute on operational initiatives to drive results
- Strong presentation and communication skills, with the ability to communicate to a wide range of audiences from senior executives to front-line employees
- Knowledge of AR management technology tools being utilized to deliver on key performance metrics and improve cost/EBIT (claims clearinghouses, advanced AR management workflow tools, advanced call center technology, disputed claims management)
- Ability to analyze data among multiple reports to determine areas for opportunity
- Advanced knowledge of process metrics (efficiency, throughput, productivity, error rate, cycle times, cost effectiveness, attrition rate, turnaround time, etc.) and how they can be used in the healthcare revenue cycle environment
- Extensive knowledge of revenue cycle metrics and drivers, particularly in billing and collections (AR days, cash goals, aging, compliance metrics, revenue integrity principles)
- Knowledge of healthcare regulatory rules and how they apply to revenue cycle operations and outsourced service providers
- Advanced knowledge of Value-Based Healthcare payment models (Episode/Bundles, Shared Savings Risk, Pay for Performance, Capitation, CMS initiatives i.e. MIPS, CJR, BPCI-A)
- Excellent oral and written communication skills
- Advanced skills with Microsoft Office, Word, Excel, PowerPoint, Access, Visio, etc.
Education and Experience:
- 4-year college degree in Healthcare Administration, Business or related area or equivalent experience
- 10+ years of experience in Healthcare Administration and/or Revenue Cycle Management
- Experience implementing and managing Value-Based Healthcare payment models
- Lean, Six Sigma or other process improvement certification is a plus
- Experience managing outsourced service providers
- Experience with the following EMR/Practice Management Systems a plus:Modernizing Medicine, CareCloud, Nextgen, Allscripts, ECW, GE Centricity, AdvancedMD, Athena