Job Summary: The Director of Revenue Cycle is accountable for ensuring the consistency and quality of the coordination of revenue cycle operation, procedures, and best practices for charge capture, billing, payment posting, collections and follow up, denials management, billing audits, and revenue cycle reporting for SRCH. This position is responsible for overseeing a strong team of medical and dental billers including medical biller leads, and payment posters. This position requires current, in-depth knowledge of governmental and commercial rules and regulations, including regulatory compliance requirements.
Specific Tasks/Duties Include:
Responsible for ensuring all RCM functions (billing, collections, cash management, reporting, and insurance contract management) are operating efficiently and effectively.
Responsible for managing the performance of a strong team of leads, medical and dental billers. Understands the job functions of all Revenue Cycle staff, is aware of process flow across departments, and involves them, as appropriate, when recommended actions may impact their work functions.
Holds regular, weekly/monthly meetings with departmental site directors and medical directors and keeps them abreast of important issues related to revenue cycle operations and regulatory billing updates.
Continually seeks ways and means for improving the delivery and support of revenue cycle activities and programs including monitoring the routine development of training material and ensuring educational resources to current and future staff.
Develops policies and procedures for all points of the revenue cycle including, but not limited to, charge capture, data entry, payment posting, insurance follow-up, collections, and denials management.
Develops and implements evaluation tools and measures staff efficiency and effectiveness.
Creates an environment of continuous improvement and innovation.
Monitors and adheres to applicable Federal, State, and local laws and regulations, in congruence to SRCH compliance and code of conduct, as well as other policies and procedures.
In collaboration with leads, monitors the payments of third-party payers for assessing compliance with established contracts. Troubleshoots problems associated with missed or unbilled charges, payment delays, denials, and other revenue cycle issues.
Review SRCH results monthly to discuss the performance of facilities.
Participate and provide input in monthly bad debt review of facilities with the finance team.
Performs enrollment for electronic billing, funds, and remittances for facilities.
Provides ongoing support and training on all aspects of billing, claims, accounting, and EHR software.
Provides ongoing support and training on eligibility and authorization process for all payer types, such as Medicaid, Medicare, Managed Care, etc.
Provides direction on the follow-up process for all payers, including claim correction and appeals
Provides direction on the collection process for private accounts, including small claims courts, collection agencies, and attorney referrals.
Conducts monthly and quarterly billing audits.
Performs and reconciles month-end close process in the EHR with reports to the CFO.
Develops and maintains a system to track, measure, and monitor key metrics such as collection rates, aging over 90 days, days in AR over time to identify trends and to monitor performance.
Maintains facility and user setup in EHR and software applications.
Maintains and updates the chargemaster in eClinicalWorks.
Employee Safety: Safely performs all duties; follows required protective protocols to ensure personal safety as well the safety of others.
Other duties as assigned by Chief Financial Officer.
Education and Experience:
Bachelor’s Degree required, MBA preferred.
Degree in health administration or related field preferred.
At least 5 years of experience within the healthcare industry, preferably in an FQHC setting.
Experience within the areas of insurance verification, benefits investigations, and reimbursement, cash management, payment posting, denials management, healthcare technology, billing, coding, customer service, counseling, teaching/education, customer-facing or back office, or experience with associated online payer systems.
Experience with eClinicalWorks preferred.
Extensive knowledge of Medicare, Medicaid, Managed Care required.
Strong computer skills with knowledge of various EHR systems preferably eClinicalWorks.
Strong analytical skills with the ability to identify trends and present information in a succinct and actionable manner.
Powerful leadership skills with the ability to coach and mentor teams through periods of high growth.
Creative problem-solving skills with the ability to multi-task and prioritize business requirements in a dynamic, fast-paced environment.
Ability to think and work creatively and effectively in a rapidly changing environment.
Exceptional customer service orientation with a focus on collaboration and flexibility when working with both external and internal stakeholders.
Demonstrate clear knowledge of SRCH structure, standards, procedures, and protocols.
Must have the ability to relate and communicate effectively with community interest groups agencies, and medical facilities that serve SRCH.
While performing the duties of this job, this position is frequently required to do the following:
Use standard office equipment and access, input, and retrieve information from a computer. Use computer keyboard with manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions efficiently for extended periods of time.
Communicate effectively in person or via telephone in a manner, which can be understood by those with whom the person is speaking, including a diverse population.
Give and follow verbal and written instructions with attention to detail and accuracy.
Perform complex mental functions; collect, interpret, and/or analyze complex data and information.
Vision: see details of objects at close range.
Coordinate multiple tasks simultaneously.
Reach forward, up, down, and to the side
Sit or stand for minimum periods of one hour at a time and come and go from the work area repeatedly throughout the day.
Lift up to 20 pounds.
Santa Rosa Community Health is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Internal Number: 1
About Santa Rosa Community Health
Santa Rosa Community Health serves our diverse community by providing excellent, culturally responsive, comprehensive primary care that is accessible to all people. We care for the whole person with compassion and respect. We cultivate a safe, supportive learning environment where employees can do their best work in a way that embraces diversity. We advocate for health care as a human right because it is fundamental to social justice.
Our vision is to improve the health and well-being of our community by transforming the health care experience so that all people have access to care and all people feel cared for; to create a lasting health care resource for our community; and to be an integral partner with the community in the promotion of health, education, and access to care. We believe that equal access to health care is essential to social justice.