Overview of the Role:
The Director of Revenue Cycle Management, Gulf Coast is responsible for the success of revenue cycle operations in our Gulf Coast market from beginning to end, from credentialing to revenue optimization. The Director reviews and enacts policies, procedures and processes related to revenue cycle functions.
This individual manages to established metrics and holds accountable the staff of the RCM & Credentialing teams on productivity, quality, compliance and outcome metrics. This individual works closely with other operating divisions including; Finance, Analytics, Implementation, Performance Management and Population Health. The Director provides leadership and clearly communicates and models the mission, vision, values and promises of Privia Health. He/she will adhere to the Privia Health Compliance Plan and privacy standards of the organization. The Director is responsible for the overall health of the full Revenue Cycle for all providers in the Gulf Coast market.
Primary Job Duties:
- Serves as the market-based senior subject matter expert on all issues surrounding credentialing, payer related issues, payer reimbursement, accurate claim processing, claim submission, collections and other general revenue cycle management
- Provides management, guidance and training to staff and will perform duties of subordinate staff when necessary to maintain practice operations
- Assures compliance with all health plan requirements as related to the provider certification and credentialing. Manages and monitors activities of the department to ensure compliance with all policies/procedures and regulations.
- Manages processes that maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
- Ensures accuracy and timeliness in all matters related to payers and manages the flow of information between the payers, contracted MSO facilities and Privia.
- Creates and manages continual process and quality improvement efforts related to payer enrollment, data entry, credentialing committees and all aspects related to credentialing & enrollment, with a focus on lean processes and reduction in overall unit cost.
- Conducts effective weekly standup and monthly staff meetings. Prepares agendas and forwards meeting notes to leadership as necessary
- Reviews daily, monthly and weekly A/R dashboards. Identifies opportunities for improvement and develops plan to implement necessary changes to meet performance expectations.
- Participates in annual budget development, and is accountable for departmental adherence to budget and/or other fiscal goals
- Works across department leadership in the Gulf Coast market to ensure seamless communication between teams
- Manages teams responsible for the accuracy and financial viability of the accounts receivable. Assigns/allocates resources as required ensuring company goals for aging and accounts receivable days are met.
- Responsible for departmental policies and procedures, providing recommendations when appropriate and ensuring compliance
- Responsible for staffing to include hiring, termination, coaching and training.
- Provides ongoing feedback to staff of performance throughout the year to subordinate staff
- Counsels employees in disciplinary matters and obtains assistance from human resources appropriately for disciplinary actions and/or employee termination process
- Performs other duties as assigned
- Bachelor's Degree from an accredited institution is preferred
- Experience with athenahealth platform strongly preferred
- Certified Professional Coder preferred. Practice management certification preferred.
- 5+ years of experience managing large, multi-specialty physician groups of varying levels of complexity
- Excellent analytical skills, facile with Excel and other tools. Must be able to critically evaluate data and make recommendations for change based on solid research and evidence.
- Solid knowledge of industry trends, regulations, payment models and demonstrated skill in managing in a complex reimbursement model across multiple provider specialties.
- Demonstrates extensive knowledge of Texas third-party and insurance company operating procedures, regulations and billing requirements, and government reimbursement programs
- Thorough understanding of medical information systems for billing and accounts receivable, spreadsheet analysis, reporting applications, medical terminology, and coding and office procedures
- Demonstrates a record of significantly improving patient accounts receivable
- Must comply with HIPAA rules and regulations
Interpersonal Skills & Attributes:
- Successful history of adding value to organizations through proactive root cause analysis and resolution of bottlenecks that negatively affect reimbursement and accounts receivable
- Strategic and tactical; able to help scale operations for significant market growth.
- Proven track record of success in pursuing efficiency and waste reduction.
- Excellent communication skills, especially in communicating with physicians, practice leaders and senior leadership throughout the organization..
- Demonstrated ability to work in a team environment and be able to effectively direct all work processes and personnel toward a common goal
- A demonstrated ability to understand, appreciate and embody how to manage through organizational ambiguity to achieve agreed upon objectives