Director of Revenue Cycle Management

Primary Health Solutions • Hamilton, OH

7d • Remote

About The Position

The Director of Revenue Cycle Management I oversees all Revenue Cycle functions and will contribute to the day-to-day operations on all issues related to the revenue cycle, provide analysis, create written processes, and train others to establish a cross-functional Revenue Cycle team. This is a remote leadership position requiring the ability to effectively manage and develop a geographically dispersed (remote) revenue cycle team.

Requirements

• Bachelor’s degree in healthcare administration, business, finance, or related field preferred
• Minimum of 7–10 years of progressive revenue cycle experience, preferably within an FQHC or community health setting.
• Experience with payer enrollment, billing compliance, coding, and payer relations.
• Demonstrated experience managing remote teams strongly preferred.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to write routine reports and correspondence.
• Ability to speak effectively before groups of customers or employees of organization.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Proficiency in electronic health records (EHR) and practice management systems (NextGen experience required).
• Sound knowledge of health insurance providers.
• Ability to serve as a mentor and subject matter expert across the organization.
• Working knowledge of regulatory requirements pertaining to health care operations and their impact on operations.
• Knowledge of professional fee billing, reimbursements and third-party payer regulation and medical terminology is required.
• Expertise in information systems to ensure multiple information streams flow efficiently and correctly through a number of varying streams using complex, industry-specific applications.
• Ability to manage multiple priorities and meet deadlines in a dynamic environment.

Nice To Haves

• Bachelor’s degree in healthcare administration, business, finance, or related field preferred
• Demonstrated experience managing remote teams strongly preferred.

Responsibilities

• Oversee the following revenue cycle functions including coding, charge capture, billing, payer enrollment, claims processing, payment posting, accounts receivable, and denial management.
• Monitor key performance indicators (KPIs) such as days in A/R, clean claim rate, denial rate, and net collection rate; implement corrective actions as needed.
• Oversee denial management strategies and appeals processes to ensure timely resolution.
• Analyze denial trends and implement process improvements to prevent recurrence.
• Ensure timely payer enrollment for all providers and collaborate with HR and operations to ensure providers are billing-ready by date of service.
• Ensure timely and accurate submission of claims in compliance with FQHC billing requirements leveraging multiple technical programs inside and outside of NextGen
• Review financial hardship applications (sliding fee scale).
• Ensure timely and professional resolution of patient billing inquiries and complaints.
• Collaborate with Patient Access Department to support the front desk with insurance billing and sliding fee knowledge
• Collaborate with Clinical Operations and Practice Optimization teams to ensure EHR/clinical workflows are compliant with FQHC billing and all revenue opportunities are billed
• Collaborate with Quality Department to optimize quality program reimbursement
• Supervise internal and external Revenue Cycle personnel in various duties, such as A/R management, issue resolution with insurance plans, collections, cash posting, contract analysis, and billing.
• Lead, coach, and develop a remote revenue cycle team across multiple functional areas.
• Oversee hiring, onboarding, training, and performance management.
• Works directly with payers and reviews payer contracts. Always negotiate for PPS methodology reimbursement with payer contracts.
• Manage vendor relationships for RCM partners such as clearinghouse and external coders.
• Attend internal NextGen committee meetings and contribute to cross-departmental projects
• Oversight/management of NextGen billing tables in file maintenance in partnership with NextGen host
• Performs all other duties and tasks as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Director