Job Description:Role SummaryThe
Director, RCM Shared Services (Urology) is responsible for leading strategic and operational initiatives for practice-based revenue cycle management (RCM) teams, third-party RCM vendors, and internal OneOncology stakeholders supporting urology practices. This position drives revenue cycle projects, utilizes analytics to optimize performance, implements best-practice workflows, and leads corporate in-house RCM teams focused on maximizing financial outcomes while maintaining exceptional patient and provider experiences.
Responsibilities- Ensure accurate coding, charge capture, and reimbursement for urology office visits, diagnostic testing, surgical procedures, surgeries and ancillary services.
- Manage relationships with third-party revenue cycle vendors and global service partners as well as leading a US-based team.
- Oversee revenue cycle processes related to cystoscopy, prostate biopsy, urodynamics, imaging, ultrasound, lithotripsy, vasectomy, catheter management, and other common urologic procedures and surgeries.
- Manage pre-authorization and medical necessity workflows for surgical and procedural services, including hospital and ambulatory surgery center cases.
- Monitor payer reimbursement trends and regulatory changes impacting urology services and develop strategies to mitigate financial risks.
- Partner with management, coding, compliance, and provider leadership to ensure appropriate application of CPT, HCPCS, ICD-10-CM, and modifier usage specific to urology services.
- Oversee denial prevention and appeals processes for specialty-specific procedures, surgical claims, medical necessity denials, and bundled service edits.
- Ensure optimization of ancillary revenue streams, including pathology, laboratory, imaging, dispensing pharmacy, and other practice-based services.
- Collaborate with management, providers and practice leaders to improve charge capture, documentation quality, and reimbursement outcomes.
- Analyze procedure utilization, reimbursement performance, RVU productivity, denial trends, and net collection metrics to identify opportunities for improvement and report out on these metrics.
- Support implementation and optimization of practice management systems, EMRs, coding edits, and automation tools to improve revenue cycle effectiveness.
- Serve as a subject matter expert regarding urology/surgery reimbursement regulations, payer policies, fee schedules, and revenue cycle best practices.
- Ensure compliance with Medicare, Medicaid, commercial payer, and governmental regulations related to urologic services and physician practice billing.
- Lead revenue cycle readiness and integration efforts for acquisitions, new providers, service line expansions, and newly implemented ancillary services and any assigned lines of business.
- Monitor vendor performance using established KPIs, SLAs, and operational metrics.
- Collaborate with RCM team to improve reimbursement, collections, denial management, and workflow efficiency.
- Serve as the primary contact for division RCM communications, issue resolution, and performance reviews actively collaborating with management on identified issues.
- Ensure vendor compliance with contractual requirements, organizational policies, and regulatory standards.
Qualifications- 5+ years of relevant healthcare and RCM leadership experience.
- Bachelor's degree or equivalent experience required.
- Experience managing third-party revenue cycle vendors or outsourced RCM services preferred.
- Contract management and vendor oversight experience preferred.
- Coding certification preferred
- Strong background in managed care payer market
- Urology experience required.
- Strong verbal and written communication skills required.
- Must be detail oriented and organized
- Strong Microsoft Office skills required, including Excel and PowerPoint.
- High integrity, including maintenance of confidential information
- Ability to work a flexible schedule based on business need, including some evenings and weekends.
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