Director of RCM Accounts Resolution

PRIMARY FUNCTION

The Director of RCM Accounts Resolution will oversee all claims follow-up aspects of the revenue cycle accounts, including timely claims resolution, payer issues management, and denials management. The Director will play a vital role in creating and implementing quality controls, day to day AR analytics, identifying root causes, bringing forth upstream solutions, and creating scalable operational foundation to support the Company’s continued growth and strategy.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.

1. Develop, evaluate, implement and maintain policies and procedures to ensure quality with claims and accounts resolution practices and maximize reimbursement of physician services while complying with all applicable government and other regulatory agencies. Maintains and updates reimbursement guidelines for third party and private insurance payers and government regulations in all states where services are provided.

2. Leads process improvement and policy development for RCM functions to include streamlining collection processes and managing accounts receivables by reconciling statements. Evaluates billing processes and procedures, identifies and optimizes operational efficiencies by coordinating efforts with the Director of Billing, Director of Mid Revenue Cycle Optimization, and other leaders at the organization.

3. Maintains effective communication with third party insurance carriers for resolution of underpaid and/or unpaid claims of one or more specialties related to the third party, government and/or patient billing for professional healthcare services.

4. Monitors reimbursement patterns of contracted and non-contracted carriers, including government agencies, and resolves issues. Escalates potential risk or critical issues to Managed Care and department leadership.

5. Translates department’s strategic goals into actionable tasks for the RCM team. Leads and provides support to the RCM team to ensure goal attainment. Leads all functions of management for the team including selection, oversight the onboarding and training program for new staff. Evaluates performance, provides feedback, and motivates staff to reach departmental established objectives.

6. Monitor staffing levels/productivity to ensure workload balance is optimal and we are aligned for growth in volume. Oversee day-to-day change management activities and regularly analyze measurable performance and KPI’s to ensure positive financial outcomes.

7. Create and review weekly, monthly, and quarterly reports and presents monthly to VP of RCM. Meets all KPIs including, AR Days, Cash Collections, AR aging, Denial Rate, Bad-debt Write-offs, and other goals set forth for the department. Monitor, track and trend major issues and communicate timely to VP of RCM.

8. Evaluate organizational efficiency and make necessary changes to maximize staff productivity. Works with billing and payment posting management to obtain optimal results in process improvement.

9. Lead special projects and reports to ensure maximum payments.

10. Perform other duties as assigned.

SUPERVISORY RESPONSIBILITIES

Oversee Billing/Reimbursement Specialists, managers of RCM for all regions

Staff – 50+ (as we continues to grow with acquisitions)

QUALIFICATIONS

EDUCATION: Minimum of Bachelor’s Degree with a focus in Business Administration, Healthcare Administration or related field required.

EXPERIENCE: Minimum of 7 years of experience directly related to RCM in health care setting required.

A minimum of 5 years in a supervisor or management capacity required.

KNOWLEDGE, SKILLS AND ABILITIES

· Proficient working with Microsoft Office including Word and PowerPoint

· Strong/Advanced MS Excel skillset and ability to run analytics

· Knowledge of medical coding and documentation education training and development preferred

· Advanced Outlook skills

· Ability to provide written and verbal presentation

· Strong analytic and problem-solving abilities

· Excellent verbal and written communication skills

· Excellent interpersonal skills with the ability to engage at all levels of the organization

· Ability to efficiently multi-task, plan and prioritize a large volume of detail-oriented work in accordance with changing deadlines, ability to communicate goals clearly and compassionately

· Accelerated knowledge and expertise in front office operations, managed care, and health care settings; current knowledge of best practices in practice management and operations.

· Knowledge of billing and collection policies and procedures, all types of insurance (HMO, PPO, POS, Medicaid etc.)

· Skill in defining problems, collection of data, interpreting billing information.

· Strong leadership and communication skills both written and verbal.

· Ability to work effectively both individually and as a team

· Ability to be creative, innovative and resourceful

· Ability to assess, use good judgement, expertise and analytics to make sound decisions

· Possess applicable knowledge of regulations impacting AR

· Maintains a current working knowledge of CPT/ICD-9 coding regulations as set forth by all related government and regulatory agencies

Job Type: Full-time

Benefits:
• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Health insurance
• Health savings account
• Paid time off
• Parental leave
• Referral program
• Retirement plan
• Vision insurance

Work Location: Remote

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