REVENUE CYCLE DIRECTOR ***Internal Posting Only – Only TCHS Employees may apply for this position***
This position contributes to the fulfillment of Thayer County Health Services vision and mission by being responsible for directing the organization’s revenue cycle departments, including Patient Access, Medical Records, and Patient Billing. This position serves as liaison with vendors who provide services for patient billing and medical record coding including overseeing vendor’s performance with claims production, billing, follow-up, collections, cash receipts/adjustments, compliance with third party payor regulations, insurance verification and provider enrollment/credentialing. This position is responsible for both strategic alignment and oversight of transaction and process-based revenue cycle functions, including ongoing improvement to key revenue cycle indicators. These key indicators include but are not limited to: A/R days, cash collections goals and posting, bad debt, denials, underpayment recovery and contract management activities related to patient account management. This individual should have comprehensive knowledge of revenue cycle operations, either from a provider or payor perspective, with particular experience in performance improvement identification/implementation and monitoring controls. This position is responsible for personnel development, implementing and maintaining department policies, and initiating disciplinary action according to policy. Responsible for the overall functions of the Health Information Management and Coding Department. Insures the highest standards for the protection of confidential information which includes the security and integrity of the electronic health records. This position also serves as the Chief Privacy Officer who oversees all activities which includes the development, implementation, and maintenance of all policy and procedures to assure compliance with the Health Insurance Portability and Accountability Act of 1996.
Reports to Chief Financial Officer.
- Bachelor’s degree required, preferably in Business or Healthcare Administration
- Master’s Degree in a related field preferred (MBA, MHA)
- Five years of progressive Revenue Cycle/Patient Financial Service management experience required
- Extensive experience in Revenue Cycle/Patient Financial Service management would be considered in place of bachelor’s degree, with a strong successful track record
- Participation in relevant industry professional associations preferred (HIMA, HFMA, NHA)
- Experience with Critical Access Hospitals and Rural Health Clinics preferred
- Must have successful history of working with CMS (Medicare/Medicaid payment plans and regulations)
- Advanced computer skills in Microsoft Office, with preferred experience in CPSI and AllScripts EHR systems
- Knowledge of CPT, ICD-9 & ICD-10 coding and hospital/physician billing
- Required current certification as an RHIT.
- Required knowledge of ICD-9 and ICD-10 in addition to CPT codes.
- Acts as liaison for vendors providing patient billing services to ensure accounts are billed accurately and timely, including but not limited to: inpatient, outpatient, emergency room, clinic, lab, rehab, and home health procedures/visits
- Acts as liaison and monitors outside collection and “early out” vendors engaged in the collection of accounts receivable, reviews and balances agency reports to hospital system reports, and approves agency invoices
- Provides operational oversight for Patient Access Team Lead and Billing Team Lead (if applicable), mentoring them in their responsibilities
- Maintains current knowledge of hospital billing systems and government payment systems, including applicable federal/state laws and regulations, as well as all aspects of third party reimbursement policies and practices
- Develops and implements policies and procedures in accordance with applicable laws, regulations, and sound business practices
- Demonstrates ability to supervise, train and motivate employees, as well as a professional attitude in relating to executive management, professionals, third-party insurance carriers, and business/community leaders
- Organizes and leads intra-departmental efforts to maximize operational efficiency and optimize reimbursement, and hold vendors accountable for their monitoring of denials and providing education and reporting to clinical areas regarding the effect of denials from their area
- Reviews all statistical reports to monitor trends, determine operational deficiencies, and implement corrective action plans as necessary
- Supervises Financial Counselors and ensures they receive appropriate training and works to resolve escalated patient complaintsDemonstrates highly developed verbal and written communication skills, excellent analytical and problem solving skills, the ability to assess and evaluate complex financial data, and the ability to manage multiple complex tasks
- Exhibits excellent leadership and self-direction, good judgment in handling difficult situations and good organizational, time management, interpersonal and conflict resolution skills
- Assures that confidentiality of patient information is maintained without exception and satisfactorily handles customer complaints within organization guidelines
- Attends all required meetings and activities, maintaining a professional affiliation to stay abreast of current trends and changes in legislation and industry best practices
- Develops and implements Health Information Management Policies.
- Develops and implements Privacy Policies in compliance with the Health Insurance Portability and Accountability Act.
- Develops and implements departmental budget.
- Develops departmental objectives and goals in addition to organizing the workload with staff.
- Interviews/hires all health information management staff in addition to performing performance evaluations and recommended wage increases, promotions, or disciplinary actions.
- Prepares statistical analysis and reports to mandatory agencies.
- Prepares the Medical Staff Meeting agenda, attends meetings, and acts as recorder.
- Actively participates in meaningful use activities to help organization stay in compliance.
- Actively participates in revenue cycle improvement activities.
- Audits records and works closely with staff to assure the completeness of the electronic health record.
- Audits electronic health records to assure compliance with access in accordance with the privacy regulations. In addition performs initial and periodic information privacy risk assessments.
- Manages and oversees transcription services.
- Oversees or ensures delivery of initial privacy training and orientation to all employees, volunteers, and contracted employees.
- Develops and implements all business associate agreements in accordance with the privacy regulations.
- Accurately assigns diagnosis and procedure codes to hospital inpatient visits, outpatient surgeries and emergency room visits.
- Accurately assigns professional fee to hospital and emergency room visits.
- Performs all Quality Improvement activities for the department.
- Participates in professional development activities and maintains professional affiliations.
- Performs all other duties as assigned