JOB SUMMARY:This position is responsible for providing strategic direction in support of critical Revenue Cycle initiatives and goals. Leads and manages complex Revenue Cycle projects and staff, drives performance, and provides the overall direction and oversight of the functional areas that support the organization's financial and operational goals, to include patient eligibility and demographics, billing, accounts receivable, and related analytics and reporting. Develops, implements, and maintains documented best practices and strategic operations related to revenue cycle functions throughout the organization. Ensures compliance with CMS and payer regulations and company policies. Fosters and promotes a culture of excellence in customer service to internal and external clients. Builds trust and collaboration amongst direct reports to create a team environment by enhancing employee engagement, addressing performance results, and providing coaching and mentoring.
ESSENTIAL DUTIES AND RESPONSIBILITIES:Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. A Coding Specialist 1 may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member.
- Partner with the RCM team to provide operational reporting, claims analysis, and workflow support.
- Develop revenue cycle KPI's and reports with focus on quality, efficiency, and throughput.
- Design decision flowcharts to help document existing workflows and quickly design new ones as needed.
- Proactively monitor the efficiency of workflows through reporting to identify bottlenecks and provide root cause analysis.
- Develop and incorporate financial models into workflows that, based on expected values and diminishing returns, help determine next best steps.
- Proactively analyze outstanding claims along with denial and collection trends to forecast collections and provide timely feedback
- Help identify opportunities for improvement and optimization through technology solutions.
- Provide workforce management reporting and analysis to better understand cost and efficiency.
- Stay abreast of regulatory requirements and overall reimbursement landscape to ensure compliance and help inform potential process changes.
- Work closely with other departments outside of the revenue cycle (e.g., Operations, Information Technology, and other internal & external departments) to streamline processes and procedures that will promote the correct and timely billing to payers and patients, thereby expediting receivables.
- Oversee the development and maintenance of departmental policies and procedures for revenue cycle departments. Communicate relevant information to other departments as necessary. Establish controls and review mechanisms to ensure procedures are being followed correctly.
MINIMUM QUALIFICATIONS & REQUIREMENTS:- 7+ years of business operations (call center, enrollment, billing, payment processing, or similar operations) experience preferably in a healthcare environment
- 3 + years of management experience including responsibilities for strategy, oversight of operations analytics and managing performance of staff.
- 5+ experience in operations related data analytics and reporting to drive performance and quality
- Health insurance and project management experience preferred.
- Strategic planning, business planning and budget development/management experience is required including strong experience at presenting data and complex analyses
- Strong motivational, written, oral, presentation and communication skills are required with the ability to adapt effectively and lead organizational change.
- Demonstrated ability to collaborate and achieve results via interpersonal and influencing skills while interacting with and adapting to varied audiences, from front line through executive leadership is required.
- Demonstrated customer focus, making internal and external customer satisfaction a priority with the ability to prioritize and manage a broad range of complex initiatives
- Proficiency in MS Office applications; database management experience a plus
PHYSICAL DEMANDS:Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described.
Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
PHYSICAL DEMANDS:Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member's function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
