Website Coastal Family Health Center
The Director of Revenue Cycle (DRC) is responsible for providing strategic direction and direct oversight for the billing staff. The DRC will continuously pursue and champion revenue cycle improvements and workflow optimization with a goal of maximizing reimbursement in a cost-effective manner in compliance with federal, state and payer-specific billing requirements.
Knowledge, Skills, and Abilities
- Knowledge of third-party billing practices and procedures including various reimbursement mechanisms such as fee for service, Medicare PPS, and capitated models.
- Knowledge of medical office practices and procedures.
- Knowledge of value-based contracting
- Knowledge of the importance of maintaining Protected Health Information (PHI) records; able to maintain confidentiality under current Health Insurance Portability and Accountability Act (HIPAA) laws and regulations.
- Ability to navigate Electronic Health Records (EHR), Electronic Practice Management (EPM) and other automated data processing systems.
- Ability to perform job duties in an effective and timely manner with minimal supervision.
- Ability to organize and use time and resources effectively.
- Ability to effectively organize and maintain files.
- Ability to follow oral and written instructions timely and accurately.
- Ability to work and communicate effectively with patients, providers, co-workers and the general public.
- Ability to effectively, efficiently and personably respond to staff and patient inquires.
- Ability to function as an effective and productive team member.
- Ability to travel to other sites, as needed.
- Ability to exercise a high degree of diplomacy and tact; excellent customer services and interpersonal communication skills; cultural sensitivity and demonstrated ability to work with diverse groups/staff members.
- Must be able to sit, stand, bend, lift, and move intermittently during the workday.
Bachelor’s Degree in Healthcare Administration, Business, Accounting or Finance. Minimum of five years of leadership experience in a healthcare setting, with FQHC experience preferred. Demonstrated experience with process analysis and improvement. Strong problem-solving skills with the ability to diagnose problems and identify solutions. Demonstrated experience developing and maintaining effective work relationships across the organization. Certified Coding Specialist or CHC Coding & Billing Specialist Certification mandatory.
- Consistently drives best practices in Revenue Cycle Management operations in or to improve administrative processes and efficiencies to increase cash flow, reduce accounts receivable days outstanding and enhance billing accuracy to minimize payer rejections and denials.
- Supervises, trains, and evaluates performance of staff in a timely manner
- Identify strengths of staff and support professional growth and skills enhancement to support organizational objectives.
- Ensures timely billing of claims and review of denials to maximize reimbursement.
- Oversees billing and claims processing for outside service providers
- Ensures timely posting of all cash receipts.
- Develops and implements policies, standard operating procedures, and training programs to achieve positive operational Revenue Cycle outcomes, including minimizing bad debt and improving cash flow.
- Develops and reviews KPI reports to identify and resolve issues that are impacting operational results. .
- Develop reports to provide consistent feedback to front line staff and providers on issues impacting efficiency and accuracy of claims and compliance with policies.
- Communicate with clinical staff and providers regarding changes needed to facilitate the processing of claims
- Oversees provider and location credentialing to minimize delays in claims processing and collection.
- Provides technical and billing assistance to clinic staff as needed.
- Monitors coding practices of providers to identify irregularities that need to be addressed.
- Exemplifies excellent customer service relations with staff, patients and intermediaries as needed.
- Assists HIT Trainers with electronic practice management and billing requests.
- Present departmental reports to the Executive Team quarterly
- Monitors charges and suggests fee updates to CFO as needed.
- Update Sliding Fee Scales to ensure compliance with HRSA guidelines
- Identify and present opportunities to maximize revenue streams through system improvements or diversification
- Competent in both oral and written English.
- Competent in use of computer software, including spreadsheets and business letters.
- Performs other duties as requested or required.
- Upholds, complies with, and enforces the Core Principles and Code of Conduct.
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