Director of Revenue Cycle Management

Cannot be remote. Hybrid possible after 90 days

Must have contacts / relationships with Private Insurance Illinois payers.

Must have experience in implementing / assisting with implementing a major EMR.

Job Summary

Director of Revenue Cycle is responsible for the direction and leadership of operational, financial, programmatic and personnel activities for Revenue Cycle, including provider enrollment, claims, payments, credit balance, insurance reimbursement, and self-pay management.

Essential Responsibilities and Metrics

The Revenue Cycle Director will ensure that all teams are trained and compliant with standards and best practices. Responsible for revenue cycle initiatives and standardization of new technology and operational functions.

The RCD will develop and implement systems, policies, procedures, and productivity standards.

• Oversee billing processes, ensuring accurate coding, submission, and follow-up on claims to maximize reimbursement. Manage the collections process, working to minimize accounts receivable and resolve billing discrepancies.
• Provide leadership and guidance to the team, ensuring the achievement of goals and objectives while fostering a positive and collaborative work environment.

Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results, setting performance expectations and goals for team members.

Conduct regular performance evaluations, provide feedback, and address performance issues.

• Oversee the planning, execution, and completion of projects and initiatives within the team.
• Establish and monitor operational processes and workflows to streamline to enhance efficiency and productivity. Implement best practices, monitor key performance indicators (KPIs), and develop strategies to achieve operational excellence.
• Set performance expectations and goals for team members. Conduct regular performance evaluations, provide feedback, and address performance issues.
• Identify skill gaps within the team and develop strategies for filling those gaps. Support employee development through training, mentoring, and coaching.

Identify high-potential employees and create succession plans.

Qualifications

Strong analytical skills, can translate complex data into clear action and can communicate it to junior and senior levels of the organization.

Advanced Excel Sheets skills preferred.

• Strong written and oral communication skills.
• Detailed-oriented, organized, and takes pride in the quality of their work.
• Strong problem-solving skills and ability to make timely decisions.
• Preferred 8+ years experience in managing healthcare provider revenue cycle management; behavioral health and / or telemedicine billing and coding experience and or certifications are a plus.
• Knowledge of professional fee billing, reimbursement, third-party payer regulation, and medical terminology is required.

Experience in creating rules around claims, credentialing and insurance for EMR

• Working knowledge of regulatory requirements pertaining to health care operations and their impact on operations.
• Experience with EMRs, including creating rules around claims, credentialing and insurance for EMR. Experience with SmartCare a plus.
• Experience with and strong knowledge of insurance landscape (experience with mental health billing is a plus).
11 days ago