Director of Revenue Cycle

Overview

The Director of Revenue Cycle is responsible for overseeing and coordinating all revenue cycle activities with a goal of maximizing reimbursement in a cost-effective manner that is in compliance with federal, state and payer-specific billing requirements. The Director oversees practice level and centralized RCM functions including but not limited to: Credentialing, Insurance Verification, Insurance Claim Submission, Insurance Claim Follow Up, Payment Posting, Patient Billing & Customer Service.

Key Role Responsibilities

• Trains and coaches managers and staff at the front desk, benefits enrollment, and billing. Sets clear expectations, monitors outcomes, creates a culture of open communication and helps team members solve complex problems through individual supervision and team meetings. Fosters a collaborative, supportive and collegial environment across departments to ensure a high-quality experience for clients and high staff morale.
• Actively develops own racial equity and inclusion lens and supports development of REI lens in colleagues. Prioritizes improving access to care through an anti-racist approach. Leads and partners across the agency to address racism and racist practices in our work, including ways to mitigate disparate outcomes in health care delivery, as well as creating an intentional and affirming workplace for people of color.
• Oversees the revenue cycle program, ensuring budget and performance goals are met. Prepares, analyzes, and maintains key revenue metrics and departmental and payer revenue performance indicators; identifies billing and collections trends for review and process improvement. Prepares and analyzes reports on billing and collections activities, as well as monthly summary reports for finance and management teams.
• Responsible for prompt, respective and effective client registration and check out. Ensures standardized, streamlined processes for the collection of client information to ensure expeditious, clean billing and reimbursement. Partners with Senior Director of Client Access to ensure intake processes are standardized implemented across all sites and locations. Partners across teams to ensure staff are well-trained and versed in both customer service and revenue cycle process, procedure, and workflow. Engages staff in performance improvement activities to continuously improve both client experience and revenue cycle efficiency.
• Leads the centralized process of client enrollment in Medicaid and/or Medicare. Responsible for managing the relationship and contract with Health Care Access Maryland and ensuring the agency meets requirements and regulations.
• Oversees timely behavioral health prior authorizations and uninsured coverage approved for clients per ACO rules. Partners with providers to improve these processes and workflows to ensure eligible clients receive authorization before services are delivered. Monitors, tracks, and continuously works to reduce claims denied due to untimely authorizations and uninsured coverage.
• Leads as the subject matter expert in athenaOne Collector of the electronic health records. Partners with Senior Director of Health Informatics and HIT team to ensure team members are aware of updates that impact revenue cycle in a timely manner.
• Collaborates with Director of Finance and the Finance team to ensure reconciliation for revenue, cash, contractual allowance, bad debt, write offs, recoveries, un-posted cash, cash deposits, and all other adjustments. Responsible for month-end reporting and receivable levels (days in AR and aging).
• Serves as liaison between the operations and clinical departments on billing, coding, and revenue cycle matters; enhance awareness of providers on ways to strengthen revenue cycle performance; work with clinical and operations teams to improve revenue generation efficiencies and reduce denials.
• Oversees third-party insurance carrier credentialing & enrollment in partnership with Human Resources. Ensures agency facilities and clinicians are enrolled and updated in a timely fashion. Manages relations with payers and providers to generate high reimbursement rates and a low level of denials. Tracks for new opportunities to enroll with third-party insurance carriers.
• Ensures compliance with federal, state, local and HIPAA privacy and security regulations as well as with terms of payer contracts.
• Maintains up to date expertise and knowledge of healthcare billing laws, rules, regulations, and developments necessary for the organization to make informed business decisions. Keeps relevant teams informed and updated regarding changes and requirements.

Key Agency Responsibilities

In addition to role responsibilities, each staff member of Health Care for the Homeless has the following responsibilities as a part of their employment:

• Models and reinforces the core values of dignity, authenticity, hope, justice, passion, and balance
• Actively participates in performance improvement and advocacy activities that support the mission
• Protects clients’ personal health information by maintaining compliance with HIPAA and other relevant health care-related IT security regulations
• Performs other duties on an as-needed basis

Knowledge, Experience and Skills

Formal Education and Training

• Bachelor’s degree in finance, business administration, healthcare administration, or related field.
• Master’s degree in business administration or related field preferred
• Demonstrated knowledge of data analysis, reporting and interpretation

• Proficiency with MS Office, including Outlook, Word, PowerPoint, and Excel
• Proficiency within an electronic health record, practice management system and/or insurance system

Experience

• Five years of management-level experience in revenue cycle at a Federally Qualified Health Center required

• Three years of experience managing teams, preferably in a hybrid work environment

• Experience working with third-party payer contracts, Medicaid & Medicare reimbursement, provider enrollment and compliance required.

• Experience working with people who are experiencing homelessness or from low-income backgrounds.
• Strong knowledge of electronic health records, practice management IT systems and insurance systems

Skills

• Able to build a team, motivate staff and delegate tasks using a strengths-based approach
• Advanced skills in accounting software and databases
• High attention to detail and accuracy
• Flexible approach, works within cross-disciplinary teams in a collaborative style
• Energetic, adaptive, and self-reflective learner
• Systems-thinker, sets clear goals, uses action plans, and knows how to prioritize.
• Builds rapport and relationships; has strong interpersonal and communication skills
• Ability to work in sensitive situations and maintain confidentiality
• Highly skilled at problem-solving; helpful to others in making ethical decisions in the workplace
• Willingly admits mistakes, self-corrects and gains insight from experiences
• Instills energy and optimism in staff for the future of the organization

Health Care for the Homeless is an equal opportunity employer and is committed to racial equity and inclusion. We make a particular effort to recruit and promote Black, Indigenous and People of Color (BIPOC) for open positions. BIPOC, LGBTQIA+ individuals, people with disabilities, and people with other marginalized identities are encouraged to apply.

This is an essential onsite position primarily based at an agency location.