Confidential Careers · 1 day ago
Director of Revenue Cycle Management
United States
Full-time
Remote
Director/Executive
$90K/yr - $100K/yr
7+ years expConfidential Careers is seeking a Director of Revenue Cycle Management who will oversee and optimize the revenue cycle process for a group of Ophthalmology clinics. This role is crucial for ensuring efficient billing, collections, and revenue realization while maintaining compliance with regulatory requirements.
Human ResourcesRecruiting
Responsibilities
Develop, implement, and oversee strategies to improve revenue cycle performance, including patient registration, charge capture, coding, billing, claims processing, collections, and payment posting
Ensure the accuracy and efficiency of medical billing and coding processes to maximize revenue collection and minimize denials
Monitor key revenue cycle performance metrics and provide regular reports to senior leadership, identifying trends, issues, and opportunities for improvement
Lead and manage the global revenue cycle team, providing guidance, training, and performance management to ensure operational excellence to members of the billing team and or clinical operation teammates to ensure effective, accurate, timely billing and recoveries
Maintain compliance with federal, state, and payer regulations, including HIPAA, Medicare, Medicaid, and commercial insurance policies
Collaborate with internal departments such as finance, clinical operations, IT, and compliance to align revenue cycle goals with overall business objectives
Develop and enforce policies and procedures to optimize workflow efficiency and reduce errors in the billing and collections process
Drive process and technology adoption, including revenue cycle management software, electronic health records (EHR), and automation tools
Resolve escalated billing and reimbursement issues, working closely with payers, patients, and internal stakeholders
Stay updated on industry trends, payer policy changes, and regulatory updates to ensure the organization remains compliant and competitive
Lead the credentialing process for Providers and follow up to ensure Providers are credentialed in a timely manner
Review insurance claims and medical records for completeness, accuracy, and billing appropriateness
Negotiate with insurance providers to ensure timely and accurate claim payments
Educate patients on available services to support informed healthcare decisions
Ensure accurate and timely collection of patient accounts
Maintain comprehensive records of patient account transactions, including insurance claims, deposits, payments, and outstanding balances
Develop and maintain strong relationships with insurance companies to ensure efficient claim processing
Audit insurance forms for errors or omissions before processing
Establish and manage accounts with insurance providers
Prepare and distribute bills to patients
Facilitates and performs charge posting, payment posting, accounts receivable appeals work, as needed
Oversee and trains charge posters, payment posters, accounts receivable appeals workers exercising outstanding analytical comprehension and leadership skills
Ability to create and interpret data analytics and reporting
Facilitate and implement edits for AI functions
Implement and maintain compliance with industry regulations and company policies
Monitor key performance indicators (KPIs) related to revenue cycle management and implement strategies for continuous improvement
Qualification
Required
Bachelor's degree in healthcare administration, finance, business, or a related field required
Minimum of 7-10 years of progressive experience in revenue cycle management, with at least 3-5 years in a leadership role
Strong knowledge of healthcare billing, coding, insurance claims, and collections processes
Exceptional Excel knowledge base and skill set required, including pivot tables
Proficiency in revenue cycle management systems, EHR, and financial reporting tools
Excellent leadership, communication, and problem-solving skills
Ability to analyze complex data and implement strategic improvements
Strong understanding of payer contract negotiations and reimbursement methodologies
Must possess the physical, mental, and cognitive skills needed to complete essential tasks, including abilities such as learning, remembering, focusing, categorizing, and integrating information for comprehension, problem-solving, and timely decision-making
Preferred
Master's degree preferred
Certified Revenue Cycle Executive (CRCE), Certified Professional Coder (CPC), or similar credentials preferred
Familiarity with Artificial Intelligence claims software
Benefits
Competitive salary and benefits package.
Professional growth opportunities and leadership development.
Company
Confidential Careers
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2-10 employees
Funding
Current Stage
Early StageLeadership Team
E
Edwin Xiao
Chief Revenue Officer
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