Job Description

The Senior Director of Patient Financial Services is expected to demonstrate, through plans and actions, a consistent standard of excellence to which all departmental work is expected to conform. Such a standard should be based on establishing and maintaining a constancy of purpose, focusing on continuous improvement within the Directors area of influence, and delivering the highest degree of quality service possible. Critical responsibilities include achievement of annual and periodic goals for significant statistical indicators for CMGs revenue cycle and patient account performance. The Director leads the organizational effort to optimize the performance of all components of patient access, scheduling, claims management and professional code auditing in all aligned medical practices. This includes all applicable elements of the patient encounter, all elements of the billing and collection cycle, appropriate areas of compliance, optimal use of available software, and management of any associated outside vendors. The Revenue Cycle Director identifies opportunities for improvement and manages the implementation of solutions.

Responsibilities

Complete various financial forecasts, including any long-range strategic plans for the department

Maintain appropriate internal control safeguards over AR records and collection of cash

Directs insurance processors and customer service representatives daily operational tasks

Ensures claims denials and rejections are logged for measurement and analysis

Ensure compliance with relevant regulations, standards, and directives

Reviews and understands regulatory billing updates

Chart process workflow

Plays an integral role in the implementation and installation of new systems and related processes

Completes random account audits weekly to identify opportunities for improvement

Collaborates with patient access to improve accounts receivable performance

Addresses medical necessity denials, authorization denials and accuracy of demographic and insurance information

Audits clinical documentation for CPT/HCPCS coding

Ensures accuracy of ICD-10 in the practice setting

Manages the claims appeal process

Maintains efficient and effective workflow in the central billing office and the revenue cycle components of all medical practice sites

Interprets complex contractual arrangements

Optimizes revenue of managed care within varied contract structures

Analyzes data, determines trends, utilizes statistical principles, and conveys financial projections for CMG

Develops the annual budget for the central billing office. Contributes to the development of the annual budget for each practice site and the Medical Group

Monitors budget variance for the central billing office

Works with Finance to assure accurate and timely reconciliation of all monies

May perform other duties as assigned or requested and job specification can be modified or updated at any time

Qualifications

Required Education: Bachelors Degree or in lieu of a minimum of ten (10) years of healthcare revenue cycle experience

Preferred Education: Masters Degree

Required Experience: Has a thorough understanding of coding methods, including CPT, ICD, and HCPCS. Able to work in a complex and changing environment. Three or more (3+) years of medical billing experience. Five or more (5+) years in a professional medical services area such as a medical office or out-patient department. Three or more (3+) years of experience managing staff