Director, Revenue RecoveryPBS
The Director of Revenue Recovery is responsible for developing, coordinating, facilitating, and implementing policies and processes in an effort to maximize the performance and integrity of the revenue cycle process in order to maximize revenue returns for the organization. In addition, creates short and long term goals to ensure that the handling of denials and appeals is done timely and accurately for the achievement of department and organizational objectives.
The role will oversee Denials and Reporting. Knowledge of Managed Care and Governmental Reimbursement. Experience with reporting systems such as Monarch, Artiva, Nomad, Access, and Excel.
Education: Bachelor’s degree in Business, Healthcare, or related field, Master’s preferred.
Experience / Knowledge / Skills:
- Five (5) years of progressive revenue cycle management experience in a healthcare organization required, including at least three (3) years of management experience.
- Proven operational and management experience in revenue cycle, including patient access, billing and collections.
- Demonstrated experience working with third party payers to expedite rebilling, appeals and resolution of outstanding accounts receivable.
- Experience managing patient access and patient accounting preferred.
- Comprehensive knowledge of Medicare and Medicaid rules and regulations, including ICD-9 (ICD-10), CPT, APC and DRG structures.
- Strong understanding of federal and state laws specifically pertaining to the revenue cycle.
- High level of interpersonal skills, problem solving and strong analytic abilities.
- Microsoft Office software expertise; experience with EMR systems and software maintenance preferred.
- Must have proven organizational skills with an ability to effectively prioritize.
- Excellent communication and interpersonal skills with a customer-service focus required; strong ability to communicate with all levels of management and staff and excellent presentation skills.
- Must be able to travel.
- Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.
- Develops, facilitates, and implements policies, procedures, productivity standards and training documents to ensure rebilling processes and claim denial appeals are processed in a compliant and timely manner.
- Directs and manages any vendor related activities attributed to the resolution of appeals.
- Directs the activities of the Revenue Recovery staff, and manages day-to-day denial resolution, communication and collaborative resolution with billing, collection teams and case management.
- Develops short and long term plan for denial reduction by major category and provides input for training patient access, case management and billing staff to obtain best practice results for cash collections and low levels of “non-contractual adjustments” and bad debt.
- Establishes monthly goals and obtains data to ensure that both internal and outsourced staff and vendors are achieving or exceeding productivity, denial reduction and cash collections goals.
- Communicates regularly and effectively with management and staff regarding the status of revenue cycle initiatives and keeps management and staff updated and trained on compliance issues.
- Collaborates with other areas of the organization as necessary to address and resolve issues that create obstacles for timely rebilling and denial resolution.
- Implement and communicate actionable plans to resolve root causes and increase cash collections; and provides any issues and concerns related to timely denial resolution toleadership.
- Determines opportunities for improvement and facilities process improvement plans to effect change in order to achieve revenue cycle best practices and ensures consistency and compliance.
- Maintains denial data scorecards, including data by each facility, place of service, payer and root cause level.
- Participates in the development, preparation, and monitoring for the department budget. Assures that revenues, expenses, contribution margin and FTE’s meet or exceed budget; prepares and submits budget and related reports; forecasts and accurately projects expenses; takes corrective action to address negative variances; identifies and proposes capital budget items appropriately.
- Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
- Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
- Other duties as assigned.