Location: Brookfield, Connecticut
We are now looking for a seasoned Director of Revenue Cycle to join our growing team at our headquarters in Brookfield, Connecticut. The Director of Revenue Cycle will be skilled in working with both established and start-up organizations and will have demonstrated expertise in creating and scaling the infrastructure required to build and optimize revenue to meet management’s short and long-range goals and objectives.
Responsibilities include managing, improving, and scaling up the claims processing functions within a rapidly-growing environment to include all components of the referral intake and fulfillment process: Intake and Quality, Verification of Benefits, Prior Authorization and Standard Authorizations, Billing and Timely Filing, Appeals/ Reconsiderations and Collections.
OPTIMIZE REVENUE CYCLE PROCESSES
- Develop, improve, and support automation and efficiency of all required business processes and Revenue Assurance models for all referrals.
- Develop and implement end-to-end controls methodology for all referrals related to current and future product offerings.
- Initiate regular checks to monitor any weakness in the control points, system or process that may result in leakage and make recommendations for process change.
- Analysis of reconciliation from source through to billing and ensuring that all referrals are received and processed in a timely, complete, and accurate manner.
- Analyze and report clearance of exceptions from all provisioning and billing systems.
- Provide comprehensive revenue risk analysis to drive internal improvements through prioritization of tasks or resolution activity to mitigate risk across business forums.
- Develop weekly and monthly KPI dashboards to reflect the overall performance of processing.
MANAGE COLLECTION OF PATIENT & INSURANCE A/R
- Oversee all corporate collections activities.
- Design, develop, modify and oversee processes and procedures for the collection of patient and insurance receivables, including processes to collect outstanding receivables and processes for collection of private pay and co-payment for services.
- Ensure compliance with Accreditation/Licensure processes to meet legal regulations and ensure implementation efficiency for individual carrier policies for billing and claim filing.
- Promote operational awareness of best practices regarding patient and insurance collections to maximize collections and reduce aging.
- Coordinate with Sales to ensure the efficacy of collections processes broadly and within individual districts and regions, developing improvement plans and revising procedures as necessary to ensure optimal collections.
- Manage and oversee patient refunds processing.
COORDINATE FEE SCHEDULES/CONTRACTED RATES TO:
- Report regularly to the Chief Financial Officer (CFO) on performance related to contracted rates and negotiation of fees with assorted insurance carriers.
- Ensure insurance receivables are maximized through proper fee schedule interpretation.
- Determine insurance fee schedule limitations and exclusions for proper billing.
- Develop a method to track and maintain all accepted insurances, archiving old or discontinued fee schedules.
- Accurately load and maintain all fees in the Billing System, ensuring fees are current and effective for relevant effective dates.
- Ensure fees are being paid at the negotiated rate.
- Initiate & support process improvement programs to enhance revenue streams.
- Help develop new reporting models and metrics to improve accuracy, timeliness, and efficiency of Revenue operations.
- Implement new control points and metrics as the business changes.
Knowledge, Skills and Abilities
- Excellent interpersonal, verbal, and written communication skills.
- Excellent presentation skills.
- Ability to multi-task and manage several projects simultaneously.
- Ability to work in a fast-paced, expanding environment.
- Excellent organization and time management skills required.
- Ability to develop alternative solutions to problems; comparing and analyzing data; preparing clear, concise, thorough, meaningful, and grammatically correct written reports, letters, memoranda, and other documents.
- Ability to independently plan, organize, prioritize, schedule, coordinate, and make decisions relating to assigned tasks and responsibilities.
- Thorough working knowledge of Windows operating systems software and Microsoft Office including, but not limited to Word and Excel and PowerPoint.
- Very skilled with billing software and able to help implement new products in this area .
Qualifications (Experience, Education, Licensure, Certification)
- Operations, Reimbursement background with 5-10 years’ experience
- Project management experience
- Payer relations experience, including negotiating or re-negotiating contracts with payers, knowledge of payer decision-making processes, internal hierarchy, and operations and industry reimbursement trends, along with Level I and Level II HCPCS codes for traditional and alternative payment models (APM) are a plus and can merit increased compensation.
- Attention to detail and financial impact
- Very strong analytical, problem-solving, writing and verbal skills
- HIPAA Training/Certification
Since this function may evolve into a small group, we will entertain strong candidates who have a subset of these qualifications to begin with the team now.