Director, Revenue Cycle Management

Tandem Diabetes Care•California - High Bluff, CA

1d•$161,000 - $205,000•Hybrid

About The Position

The Director, Revenue Cycle Management (RCM) is an integral part of the financial operations’ infrastructure, creating and implementing policies and best practices for the billing and reimbursement function and ensuring that billing and collection activities are timely and accurate. The role is responsible for all aspects of revenue cycle functions, including A/R review, billing, collections, payment posting and patient financial services. With a thorough knowledge of reimbursement billing, claim resolution, and collection techniques, partners with other departments to drive strategy and minimize potential losses. The RCM at Tandem is also responsible for: Strategically sets goals and objectives for reimbursement team including headcount, budgeting, process, and system requirements. Influence all revenue cycle processes, including developing, revising, and enforcing policies, goals, and best practices to effectively manage the company receivables. Develop, redesign, and monitor key performance indicators including customer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other parameters. Closely liaising with the revenue accounting team & financial reporting team to ensure proper revenue recognition. Engage in cross-functional and interdepartmental teams involving process improvement initiatives and projects for the organization. Strategize and partner with Customer Support team to minimize potential losses. Create and implement a patient financial service strategy. Serve as the subject-matter expert (SME) on regulatory, compliance, and legal requirements associated with medical billing. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies, governmental and third-party payers. Evaluate billing system, lead new system selection, and drive implementation effort, as needed. Continually looks for opportunities to automate routine reimbursement tasks through technology. Deliver comprehensive reporting to senior management that communicates relevant trends, KPIs, and analytical insight into performance. Collaborate extensively with finance, compliance/legal, sales operations, managed care, and leaders to ensure the execution of a fully integrated revenue cycle and that the organization is on track to accomplish established objectives. Ensure that departments, functions, and teams are operating in compliance with payer requirements and patient expectations, as well as the company's policies and procedures. Ensures department’s adherence to company policies, including Privacy/HIPAA, as well as other legal and Regulatory directives.

Requirements

B. S. in Business Administration, Accounting, Finance, or other relevant discipline or equivalent combination of education and applicable job experience.
10+ years of experience in finance and/or operations.
5+ years in an RCM leadership role within a healthcare system.
Successful track record of developing and implementing processes and procedures to ensure timely and effective billing and collection of medical reimbursement and patient receivables.
A track record for successfully defining the appropriate structure, personnel, processes, and measurements to successfully meet the company’s billing and collection needs and making the requisite changes as the company’s needs change.
Strong understanding of healthcare billing, coding, and reimbursement principles, as well as industry regulations.
Demonstrated knowledge of Federal and State regulations regarding medical reimbursement, documentation, and coding.

Nice To Haves

Master’s degree in relevant discipline, preferred.
Certification in Medical Billing, preferred.
DME and pharmacy experience preferred.
Experience in a high volume, medical device, biotech, or pharmaceutical environment, preferred.
Knowledge of US GAAP, particularly revenue recognition rules preferred.

Responsibilities

Strategically sets goals and objectives for reimbursement team including headcount, budgeting, process, and system requirements.
Influence all revenue cycle processes, including developing, revising, and enforcing policies, goals, and best practices to effectively manage the company receivables.
Develop, redesign, and monitor key performance indicators including customer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other parameters.
Closely liaising with the revenue accounting team & financial reporting team to ensure proper revenue recognition.
Engage in cross-functional and interdepartmental teams involving process improvement initiatives and projects for the organization.
Strategize and partner with Customer Support team to minimize potential losses.
Create and implement a patient financial service strategy.
Serve as the subject-matter expert (SME) on regulatory, compliance, and legal requirements associated with medical billing.
Ensures compliance with relevant regulations, standards, and directives from regulatory agencies, governmental and third-party payers.
Evaluate billing system, lead new system selection, and drive implementation effort, as needed.
Continually looks for opportunities to automate routine reimbursement tasks through technology.
Deliver comprehensive reporting to senior management that communicates relevant trends, KPIs, and analytical insight into performance.
Collaborate extensively with finance, compliance/legal, sales operations, managed care, and leaders to ensure the execution of a fully integrated revenue cycle and that the organization is on track to accomplish established objectives.
Ensure that departments, functions, and teams are operating in compliance with payer requirements and patient expectations, as well as the company's policies and procedures.
Ensures department’s adherence to company policies, including Privacy/HIPAA, as well as other legal and Regulatory directives.