Job Description

Job Description

The Director of Revenue Cycle Management is responsible for overseeing the entire revenue cycle function within one of the largest and fastest growing dermatology practices in Florida. Key responsibilities include oversight of billing, coding, collections and denial management with responsibility for ensuring claims, denials and appeals are efficiently processed and resolved. The Director of Revenue Cycle Management will effectively manage accounts receivables, minimize bad debt, improve cash flow and compile and report key performance indicators to the executive management team. The Director will be responsible for setting the annual practice fee schedule, staying apprised of coding and revenue trends and providing coding education to clinical and coding/billing staff. In addition, this position will manage all Revenue Cycle Management staff including billers, coders and the RCM/Admissions Supervisor; this will include day to day supervision as well as development opportunities, training and mentorship.

Role and Responsibilities:

Clinical and Administrative

• Oversee and manage entire revenue cycle including billing, coding, collections, and denial management
• Manage relationships with external vendors for practice management software and clearinghouse vendor
• Communicate professionally with various payers
• Manage, develop and mentor all revenue department staff, including billers and coders and RCM/Admissions Supervisor
• Provide up to date education for clinical, billing and coding staff on coding trends
• Develop, evaluate, implement and revise policies and procedures related to billing, coding, reimbursement activities and improvement strategies
• Reconcile all receivables and revenue reports and work closely with the finance department in the development of the monthly financial statements
• Compile and report key performance indicators to the executive management team, including the Chief Financial Officer and Chief Operating Officer, and interpret key trends or changes on week-to-week and month-to-month basis
• Manage and update the charge master based on the current CMS fee schedule and negotiated contracts
• Conduct monthly analysis of Medicare/Medicaid/Third Party Payers
• Review and resolve issues related to claim generation and rejected/denied billings
• Commit to highest level of business and patient confidentiality possible adhering to all HIPAA and security guidelines when accessing and sharing patient information
• Keep abreast of all reimbursement billing procedures of third party and private insurance payers and government regulations
• Maintain appropriate internal controls over accounts receivable and RCM process
• Monitor accounts sent for collection and reimbursements from insurance companies and other third-party payers
• Review, monitor and evaluate third party reimbursement and research variances. Participate in the development of coding and billing strategies, evaluating process relative to revenue cycle, and making recommendations while ensuring compliance with any relevant rules or regulations (including HIPAA, Medicaid, Medicare, and specific 3rd Party Payors)
• Direct billing, coding and collections responsibilities as needed, especially during peak activity periods
• All other duties as assigned

Qualifications and Education Requirements:

• A bachelor’s degree and at least 5 years of related work experience, ideally within a multi-location healthcare environment
• Knowledge of general computer programs, EMR systems, customer service, excellent verbal communication skills
• Knowledge of third-party payer requirements including federal, state and private health care plans and authorization process
• Proven experience in healthcare billing, including Medicaid/Medical Assistance
• Knowledge of basic insurance policies, procedures and reimbursement practices with Medicare coding
• Experience supervising staff

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