Director of Revenue Cycle Management - Skin and Cancer Institute

SUMMARY OF POSITION

The Revenue Cycle Manager will work under the general supervision of the Controller. This position is responsible for ensuring that patient billing and processing of payment receipts are consistently completed in a timely and in accordance with policy. The Revenue Cycle Manager will minimize bad debt, improve cash flow and effectively manage accounts receivable. This position will coordinate effective management of revenue cycle activities across the organization, including front desk, billing, collections, financial counseling for patients and staff training. This role will provide general oversight to the Credentialing office.

 ESSENTIAL DUTIES

• Supervise and evaluate assigned support staff in a timely manner. This position will supervise biller/coders, FSRs and PSRs.
• Ensure accuracy of deposits, demographic and other information in the patient billing system.
• Participate in program/service evaluation activities; facilitate changes in provision of service based on Continuous Quality Improvement results. Participate in preparation of annual UDS report.
• Monitor data integrity for the practice management system. Report problems to the CEO or other appropriate personnel in a timely manner.
• Provide a monthly summary on the status of outstanding charges in the oldest column of the Accounts Receivable Aging report for all balances over $________.
• Provide monthly report on the status of credit balances. (Unapplied Credit Analysis Report)
• Monitor gross charges to determine the potential need for an update to the fee schedule annually. Report findings and recommendations.
• Coordinate with the Practice Managers to stay current on credentialing issues, especially in the case of new providers, with an emphasis on scheduling mainly self-pay patients for the new providers until they are credentialed with third party organizations.
• Monitor volume of charge and collection posting monthly to confirm that Billing Specialists are keeping up with patient encounter volume. Recommend and/or implement changes to work schedule, as needed, when workflow in the Billing Department is significantly behind.
• Responsible for ensuring the timeliness of processing and correction of rejected claims.
• Maintain rosters of Managed Care patients for all plans which have been active within the two most recent calendar years.
• Maintain regular schedule for sending out billing statements in accordance with the Financial Policies and Procedures.
• Maintain and process for review of all billing statements which are returned to sender. Utilize public records and other resources to make best effort to obtain accurate billing addresses.
• Maintain a regular schedule for writing off bad debts, including a process which requires, and documents attempts to collect or resubmit prior to removing the charge from outstanding receivables. Submit Bad Debt Write Off Report to CEO.
• Monitor coding practices among providers to determine potential patterns of under coding or other irregularities.
• Keep Billing Specialists up to date on third party coverage contracts, ensuring that current contractual terms are understood and applied correctly.
• Establish and maintain a regular follow-up process on patient accounts pending approval for third-party coverage.
• Maintain current information for billing and collections processes for each third-party carrier in a Billing Manual.
• Work with Practice Managers and Schedulers/call center to assure patients are informed of requirements such as income and/or insurance verification when the appointment is scheduled. Confirm that patients who have coverage that is not accepted at our organization are made aware of this fact before an appointment is scheduled.
• Ensure that the need for referrals and/or authorizations are addressed when scheduling the appointment.
• Train PSRs/FSRs to identify uninsured patients who may qualify for Medicaid or other programs which can cover some or all charges.
• Maintain process for verifying insurance at the time of each billable patient encounter.
• Monitor and identify any patterns in remittance advices which would indicate the PSRs are not properly collecting insurance information. In coordination with Practice Manager, initiate retraining and/or other corrective action indicated.
• Maintain a process of coverage verification for scheduled patients prior to appointment.
• Coordinate the Revenue Cycle Management team to address any deficiencies in staff performance uncovered by internal audits.
• Must hold all patient Protected Health Information (PHI) and other patient personal information and agency information in confidence, in accordance with the Employee Confidentiality Statement, which you have read, understand and signed.
• Actively participates in and complies with all aspects of the NHFHS Corporate Compliance Program, follow the Program Code of Conduct and obey all relevant laws, statutes, regulations and requirements applicable to Medicaid, Medicare and other State and Federal health care programs.
• Participate in CQI, other internal committees, special projects/observances or activities that promote improvements in organizational performance and/or advance the mission, goals and objectives of Family Health Centers.