Title: Director – Revenue Cycle
FTE: 1.0 FTE (40 hours/week)
Schedule: Primarily Monday-Friday from 8:00 am – 4:30 pm
Holiday Rotation: N/A
Weekend Rotation: N/A
Oversees the overall policies, objectives and initiatives for Sauk Prairie Healthcare’s revenue cycle activities. Responsible for management, direction, and leadership of the Business Services, Patient Services, and Coding departments. Reviews, designs and implements processes surrounding pricing, coding, billing, third party payer relationships, collections and other financial analyses to ensure that clinical revenue cycle is effective and properly utilized. The Director also works closely with Finance and other departments in the coordination of certain reimbursement and budgeting functions. Position oversees the pre-admission and financial clearance processes in all areas, to ensure that payor requirements are met and the patient experience is positive.
POSITION TECHNICAL RESPONSIBILITIES:
- Direct activities related to revenue cycle management from pre-registration through final account resolution, including registration, charge entry, coding, hospital and clinic billing, and collections.
- Propose and implement policies and procedures, work rules and performance standards to ensure the efficient and effective operation of Sauk Prairie Healthcare’s Revenue Cycle departments in compliance with organizational standards and federal, state and local laws.
- Evaluate and direct efforts of analysis to improve Revenue Cycle initiatives.
- Lead Revenue Cycle and clinic/provider process improvement activities, identifying areas in the Revenue Cycle that are not working efficiently or effectively.
- Work collaboratively with clinical areas, Finance, and Information Services to identify and resolve charging issues and opportunities when applicable.
- Perform on-going monitoring and auditing of areas assigned to ensure appropriate documentation, coding, charging, etc.
- Establish, maintain, and conduct periodic analysis of overall pricing policies around annual charge increases and algorithms for service, product and drug pricing.
- Coordinate chargemaster changes, maintenance, and reviews. Works collaboratively with other departments to identify and implement needed improvements in the charge entry process.
- Coordinate 3rd party audits and denial management processes, including tracking trends and responding with potential process improvements to reduce future denials.
- Oversee the process of payor contract management to validate payments received reflect contracted reimbursement rates and appealing claims where payment discrepancies exist.
- Develop and maintain policies and procedures regarding Sauk Prairie Healthcare’s Community Care and Financial Assistance programs. Oversees staff and external contracted vendors working with uninsured or underinsured patients to identify opportunities to assist the patient in obtaining insurance coverage for healthcare services.
- Direct the continued development and deployment of patient price and out-of-pocket liability estimation processes to meet the changing expectations of healthcare stakeholders.
- Coordinate activities related to new provider credentialing and periodic revalidations of credentialing with commercial and governmental payors.
- Provide analysis and support for payment strategies, including the Medicare Cost Report, managed care contracts, and pricing strategies. Works with the Finance Department and CFO to accurately budget revenue and deductions from revenue.
- Provide input into short and long-term strategic plans, goals, objectives and budgets.
- Lead monthly Revenue Cycle Committee meetings.
- Participate or delegate participation in Health Information Operations committees to ensure that department business processes are optimally designed to take advantage of Meditech system and that the Meditech system is designed to meet the needs of the Revenue Cycle.
- Ensure that business processes are designed to ensure the confidentiality of patient protected health information and meet HIPAA standards. Provide education to staff on HIPAA.
- Demonstrated commitment to SPH quality improvement program. Develops and maintains quality control programs and Quality Initiatives activities.
- Prepare and oversee department budget. Ensures that fiscal responsibility is exercised in all financial decisions.
- Responsible for hiring, orienting, training, on-going education, evaluating and supervising department staff. Implements retention strategies.
- Demonstrate leadership skills in motivation, managing change, delegation, conflict resolution, and written and oral communication. Facilitate regular staff meetings.
- Promote professional growth of self and staff.
- Develop and maintain team concept in departments. Motivates staff to continually move toward performance excellence.
- Foster effective working relationships with and among employees, as well as with customers and staff from other departments.
- Demonstrate knowledge of Hospital policies, procedures and practices and own legal responsibilities related to employment law including, but not limited to, sexual harassment, Family and Medical Leave Act, Wage and Hour, Labor Law, Americans with Disabilities Act and disciplinary processes.
- Serve as a subject matter expert for department managers, staff, physicians, and administration for obtaining information or clarification on documentation standards, state and federal law, and regulatory requirements relating to Coding.
- Oversee documentation and medical coding functions to support revenue integrity, clinical documentation improvement, and compliant reimbursement.
- Actively participates in various committees such as, but not limited to, the Medical Staff Quality Improvement and Utilization Review.
- Responsible for initiating, implementing, and maintaining contracts with vendors for outsourced Coding, Business Services, and Patient Services departments.
- Oversee implementation and adherence to the Coding compliance and clinical documentation improvement programs.
- Responsible for oversight of all Recovery Audit Contractor (RAC) activities.
- Foster strong working relationships between medical staff, administration, and Coding personnel.
- Required: Bachelor’s Degree.in healthcare administration, business administration or related field.
- Preferred: None
Licenses and Registrations
- Required: A minimum of 3 years of experience in a health care setting with extensive exposure to revenue cycle functions. Prior direct supervisory experience.
- Preferred: None
- Required: None
- Preferred: None
- Required: Certified as a CRCE (Certified Revenue Cycle Executive) within two years of being in position. Other certifications may be substituted (e.g. CRCR, CHFP), with prior approval of the Chief Financial Officer.
- Preferred: None
- Competitive health and dental insurance options
- Flexible paid time off to balance work and life
- Retirement plan with immediate vesting and employer match
- Free membership to our state-of-the-art fitness facility
- Generous tuition reimbursement
- Employer provided life and disability insurance