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Director, Revenue Cycle Management

Company: CNY Family Care LLP
Location: East Syracuse
Posted on: September 25, 2022

Job Description:

Management position responsible for directing and coordinating the overall functions of Practices Revenue Cycle. Responsible for maximizing collections and reimbursement in a cost-effective manner in compliance with federal, state and payer specific billing requirements. Ability to build strong patient, physician, and staff relationships important. Requires strong managerial, leadership, and business office skills, including critical thinking and the ability to produce and present detailed billing activity reports.
Duties and Responsibilities include the following. Other duties may be assigned.

  • Oversees the operations of the billing department, encompassing medical coding, charge/data entry, financial counseling, claims submissions, payment posting, accounts receivable follow-up, collection of patient balances and reimbursement management. *
  • Responsible for producing monthly Revenue Cycle dashboard for the partner physicians, including but not limited to gross charges; A/R Days, Copay Collection Rate, Weekly Charges Entered, Weekly Payments, Total Pre A/R, Denials, Total outstanding A/R; Average charge per visit, and number of claims submitted. Updates Excel worksheet with month end numbers by provider. *
  • Serves as the practice expert and go to person for all coding and billing processes. *
  • Plans and directs patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection. *
  • Maintains contacts with other departments to obtain and analyze additional patient information to document and process billings. *
  • Reports at least monthly to executive management and partner physicians. *
  • Prepares and analyzes accounts receivable reports, weekly and monthly financial reports, and insurance contracts in concert with the COO/CFO. Collaborates with CFO to contribute to cash reconciliation activities and to assist in the assessment of accounts receivable collectability and validation including writing off bad debts. *
  • Responsible for the charge master and for maintaining fee schedule. *
  • Audits current procedures to monitor and improve efficiency of billing and collections operations. *
  • Ensures that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol, and are following all practice policies, Federal, State, and payer regulations, guidelines, and requirements including but not limited to HIPAA, 42CFR and CMS. *
  • Participates in the development and implementation of operating policies and procedures. *
  • Reviews and interprets operational data to assess need for procedural revisions and enhancements; participates in the design and implementation of specific systems to enhance revenue and operating efficiency. *
  • Analyzes trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff and revise policies and procedures. *
  • Performs proactive audits on all recommended A/R write offs and presents audit results to Executive Management. *
  • Identifies and troubleshoots Electronic Interchange (EDI) issues and works with EHR vendor to correct and implement system upgrades to maximize practice management system utilization. *
  • Keep up to date with carrier rule changes, and fee schedules for all payers and distribute the information within the practice. *
  • Assist CEO with negotiations and maintenance of payer contracts with all carriers and payer sources for the practice. Assist with review of contracted rates versus reimbursements. *
  • Understands and remains updated with current coding and billing regulations and compliance requirements.*
  • Maintains a working knowledge of all health information management issues such as HIPAA and all health regulations.*
  • Maintains library of information/tools related to documentation guidelines and coding.
  • Provides, oversees, and/or coordinates the provision of training for new and existing billing/front end staff on applicable operating policies, protocols, systems and procedures, standards, and techniques. Keeps all practice staff informed of carrier rule changes and provides training and support to other departments as needed.*
  • Coordinates team member weekly schedule and time off in a manner that does not negatively impact necessary daily functions. Reviews and approves department time in payroll system. *
  • Performs other miscellaneous job-related duties as assigned.

    Supervisory Responsibilities:
    Manages non-supervisory employees in the Billing Department. Is responsible for the overall direction, coordination, and evaluation of these units. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Monitors staff productivity and implements new quality improvement processes. Compares productivity and efficiency to national benchmarks. Establishes Key Performance Indicators, monitors, and reports to executive management. Motivates employees to achieve peak productivity and performance.
    Associates degree, preferably in business administration or related field. Bachelor's Degree preferred or equivalent combination of education and experience. Minimum of ten (10) years Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system, with a deep understanding of medical billing rules and regulations. Five (5) years supervisory or management experience. A combination of education and experience will be considered. Certified Professional Coder (CPC) is preferred.

    Knowledge, Skills and Other Abilities:

  • Thorough understanding of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; strong knowledge of NYS and Federal payer regulations.
  • In depth knowledge of CMS regulations, processes and carrier's manual.
  • Working knowledge of CPT and ICD9/10 codes, HCFA 1500, claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
  • Knowledge of business management and basic accounting principles to direct the billing and coding office.
  • Sufficient knowledge of policies and procedures to accurately answer questions from internal and external customers.
  • Possess excellent negotiation skills, including the tact required for securing payment or discussing patient's finances, and enjoy working in a health care setting.
  • Up to date with health information technologies and applications.
  • Knowledge of clinic's strategic business objectives and employee performance objectives.
  • Knowledge of governmental and health care fiscal regulations and reporting requirements.
  • Experience with physician credentialing process.
  • Skill in exercising a high degree of initiative, judgment, discretion, and decision-making to achieve objectives.
  • Skill in evaluating operations as they relate to policies, goals and objectives, costs, and rate levels.
  • Skill in establishing and maintain effective working relationships with patients, medical staff, and the public.
  • Detail oriented and tolerant of frequent interruptions and distractions from patients and staff.
  • Skill in identifying and resolving accounting and financial problems.
  • Ability to create an atmosphere that encourages motivation, innovation, and high performance.
  • Ability to delegate responsibility and authority to staff.
  • Ability to work under minimum supervision and demonstrate strong initiative.
  • Ability to supervise and train employees, to include organizing, prioritizing and scheduling work assignments to meet practice timelines.
  • Ability to deal in an organized manner with problems involving multiple variables within the scope of the position.
  • Ability to communicate effectively with physicians, patients, insurers, colleagues and staff.
  • Ability to make independent decisions when circumstances warrant; make prompt and accurate judgments regarding AR, billing and other office duties.
  • Ability to recognize, evaluate, solve problems, and correct errors, and to develop processes that eliminate redundancy.
  • Ability to conceptualize workflow, develop plans, and implement appropriate actions.
  • Ability to communicate effectively in writing, over the telephone, and in person.

Keywords: CNY Family Care LLP, Syracuse , Director, Revenue Cycle Management, Executive , East Syracuse, New York

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