Director of Revenue Cycle

Company: Golden Valley Health Centers
Location: Fresno
Posted on: June 21, 2022

Job Description:

The Director of Revenue Cycle is responsible for ensuring 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, revenue cycle reporting and all other aspects of community health center revenue cycle. Manage the activities of the centralized billing staff through daily supervision while overseeing all billing, coding, and accounts receivable functions.This position will work at our Frenso site.Schedule is Monday - Friday, 8:00am - 5:00pmEssential Duties and Responsibilities

• Organize and direct all activities to ensure control and management of patient accounts receivable, including charge capture, claims production, claims scrubbing, billing, collections, customer service, denial management, cash posting, and follow-up on collection services.
• Ensure accurate and timely submission of all claims, and timely collections.
• Organize work and set priorities for direct reports and for the department. Ensure that direct reports and their staff are meeting our patients' expectations about quality, service and responsiveness;
• Collaborate and communicate with multiple levels of management across the organization.
• Establish and maintain all billing and financial data, including medical billing code tables, rate schedules and payer information.
• Promote data-driven decision-making in a culture of high performance and continuous improvement that values learning and a commitment to productivity and quality assurance.
• Analyze significant financial trends and events to share relevant findings with key stakeholders to drive challenging management decisions.
• Oversee the development and maintenance all reporting processes for key performance indicators and will analyze and redesign processes as needed to improve key performance indicators.
• Analyze reimbursement from all sources, including carrier reimbursement exception reporting and follow up pending claims analysis and denials management.
• Assure maximization of cash collections through diligent and timely monitoring of all open accounts receivable balances.
• Develop, implement, and update training, policies and procedures to improve the functionality of all steps within the revenue cycle, and improve revenue cycle performance. Ensures consistent quality and manages all billing operations, including hiring, orientation, training, development, coaching, corrective actions, and timely performance reviews for direct reports. Lead process reviews to improve quality, efficiency, effectiveness of revenue cycle activities.
• Collaborate to ensure proper enrollment of GVHC and compliance with individual providers for all public and private insurance programs.
• Participate in patient contract negotiations; ensure proper implementation of patient contract programs to ensure compliance, eligibility, service delivery, billing functions and maximize collection functions.
• Maintain and foster excellent payer relations with key fiscal intermediaries and government oversight agencies.
• Provide departmental direction and supervision, including a vision for future direction of revenue cycle activities.
• Ensure the organization complies with all laws and regulations related to the revenue cycle, including coding and HIPAA.
• Lead the process to systematically evaluate, monitor and report on regulatory compliance related to the revenue cycle.
• Establish and utilize an account denial and/suspense process to monitor and minimize payer denials and suspensions.
• Coordinate audits related to billing, coding and patient accounts receivable.
• Monitor credit balance reports to ensure accurate and timely refunds.
• Monitor and ensure compliance with applicable timely refund requirements, such as CMS 60-day rule.
• Other projects or duties as assigned.Physical Demands
  • Lift up to 30 pounds occasionally and push up to 50 pounds (on wheels) on rare occasions.
  • Must be able to hear staff on the phone and those who are served in-person, and speak clearly in order to communicate information to clients and staff.
  • Must have vision with or without lenses that is adequate to read memos, a computer screen, personnel forms and clinical and administrative documents.
  • Must have high manual dexterity.
  • Must be able to reach above the shoulder level to work, must be able to bend, squat and sit, stand, stoop, crouching, reaching, kneeling, twisting/turning, fingering and feeling.Work Environment The physical environment requires the employee to work indoors, primarily in an office setting. The noise level inside is quiet to average. Use of general office equipment is required on a daily basis. Travel may be required at times.Education/Experience RequirementsMinimum Qualifications:
    • Excellent working knowledge of patient financial service operations with focus on community health centers, public insurance, and managed care.
    • Knowledge of all functional areas of revenue cycle, including registration, billing, charge capture, AR management, bad debt analysis, utilization review, managed care contracting terms, health information management, information systems, State and Federal billing regulations; demonstrated experience in diagnosing, evaluating and developing corrective actions for problems within revenue cycle operations.
    • Well-versed with all federal, state and HIPAA privacy regulations with thorough knowledge of CPT and ICD-10 coding protocols and procedures.
    • Strong computer skills including experience with EPIC, Microsoft Excel, Word, Outlook.
    • Demonstrate strong organizational and leadership skills in a fast paced, growing environment.
    • Handle confidential materials and information in a professional manner.
    • Ability to effectively influence change; forge effective working relationships with direct reports, members of leadership team, key executives, external government and non-government stakeholders.
    • Attention to detail and capability to apply discretion and sound judgment in managing complex processes, decisions and handling sensitive information with awareness of impact to others.
    • Demonstrate effective communication.
    • Demonstrate experience, creativity and evaluative thinking skills to assess problems and find solutions;
    • Exemplify responsible, ethical and honest behavior at all times.
    • Demonstrate the ability to present facts clearly which leads others to share their perspectives and ultimately reach agreement.
    • Develop good relationships with individuals internally and externally.
    • Prioritize and balance workload on short and long-term company needs.
    • Valid CA Driver's License, reliable transportation, acceptable driving record, and liability insurance.Education/Experience
      • High school diploma or equivalent.
      • Bachelor's degree in finance/accounting, business administration, healthcare administration/management, or related field.
      • Master's degree in business administration, or related field, preferred.
      • A minimum of five (5) years of experience managing a staff of professionals in the revenue cycle.
      • Billing Director experience in a Community Health Center, preferred.

Keywords: Golden Valley Health Centers, Fresno , Director of Revenue Cycle, Executive , Fresno, California