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Campbell Clinic Orthopaedics · 1 day ago

Director of Revenue Cycle

Germantown, TN

Full-time

Onsite

Lead/Staff, Director/Executive

5+ years exp

Campbell Clinic Orthopaedics is seeking a Director of Revenue Cycle Management to oversee and coordinate all revenue cycle activities. The role focuses on maximizing reimbursement while ensuring compliance with billing requirements and improving patient financial interactions throughout the care continuum.

Health Care

Responsibilities

Oversee and support the daily operations of all patient financial services (PFS) functions, including billing, follow-up and collections, cash posting and all Patient Access areas

Work closely with other departments (HIM, Case Management, Information Technology, Clinics, etc.) to streamline procedures that will help ensure correct billing to patients and payers in a timely manner, thereby expediting Clinic receivables

Oversee the work schedule and direct changes in priorities and schedules as needed to ensure work is completed in an efficient and timely manner and to improve the department’s performance and service

Implement a Quality Assurance program for PFS functions and monitor staff and team performance, making changes, when required, to support accurate billing to payers and patients in a timely manner and compliance with laws and department procedures

Assist with the development of budgets and monitoring of department operations to achieve goals within the budget

Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers

Maintain appropriate internal controls for the safeguarding of cash

Follow and monitor compliance with Clinic policies and standards

Develop, redesign, and monitor key performance indicators including payer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other requested parameters

Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers

Serves as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers

Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implementing solutions

Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks

Responsible for maximizing the collection of medical services payments and reimbursements from patients, insurance carriers, financial aid, and guarantors

In conjunction with operations, reviews and enhances insurance verification, coding review, billing, collection, and payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current workflow

Monitors daily productions of claims, denials, and appeals

Analyzes claims, utilization, and medical cost data

Monitors aged accounts and verify appropriate collections procedures are being followed

Reviews, monitors and recommends updates to the Clinic’s fee schedule to maintain fees at levels that maximize reimbursement

Ensures compliance with relevant federal, state, and payor-specific billing requirements

Regularly provides upper management with revenue cycle status including reports, metrics, and presentation

Establish a regularly scheduled revenue cycle meeting to discuss strategies and ensure everyone is educated on the direction of the department

Work with Managed Care vendors in identifying any payer relation issues or contracts that need to be renegotiated or negotiated for the first time

Any and all other projects, goals, issues surrounding the revenue cycle, conflicts or concerns as directed or indicated by Administration

Qualification

Revenue cycle managementBillingCollectionsRegulatory compliancePatient financial servicesAnalytical skillsTraining managementMotivating othersFoster teamworkCoachingMicrosoft SuitePresentation skills