Senior Director of Revenue Cycle

Job Description

Job Description

WE ARE HEALTHCARE SYSTEMS OF AMERICA. Our mission is to elevate healthcare standards, improve patient outcomes, and create value for communities across the United States. Healthcare Systems of America (HSA) is more than a healthcare provider-we're a community built on excellence, innovation, and compassion. If you're looking for a career that makes a difference, empowers you to grow, and gives you the opportunity to impact lives, HSA is where you belong.

Healthcare Systems of America operates 8 community hospitals across 3 states. We service a multitude of patients and their families across our vast network, while remaining committed to the professional development of our staff, the functional improvement of our patients, and the cultivation of strong partnerships within our communities.

WHAT WE OFFER

• Career Growth & Development - We are an essential, stable and growing company with many opportunities for training and advancement within the medical field that all employees and team members can benefit from.
• Supportive & Inclusive Culture - We foster an environment where every team member is valued, heard, and empowered to succeed.
• Meaningful Work - Every day, you'll contribute to patient care, cutting-edge medical solutions, and life-changing treatment and technologies.

POSITION SUMMARY

The Revenue Cycle Director sets procedures for filing reimbursement claims and ensures timely and accurate claims payments. Monitors, evaluates and reviews all cost reporting in support of reimbursement claims, and develops policies and procedures compliant with fiscal and regulatory requirements.

The successful person in this role oversees the collection of statistical and financial data needed for preparing annual and monthly health insurance reports and provides input to strategic decisions that affect the functional area of responsibility. Additionally, the Reimbursement Director will oversee all tasks assigned to the revenue cycle department staff, to include identifying patient reimbursement issues, ensuring that claims, denials, and appeals are efficiently processed, resolving billing-related issues, and code diagnoses and procedures correctly.

PRIMARY RESPONSIBILITIES

• Review, support, mentor and guide Healthcare Systems of America on systems, nursing standards and guidelines.
• Ensure that reimbursement structures are managed, evaluated, and capture accurate utilization at the facility level.
• Responsible for partnering with clinical and financial team members to develop and enhance clinical reimbursement tools and systems.
• Educate Healthcare Systems of America on the review process and provide recommendations to address potential areas of concern/opportunity, utilizing programs and reports on various state and company generated reports.
• Provide education as needed to Corporate Office, other regional personnel, and facility personnel on Medicare/Medicaid/Restorative/EMR regulatory issues.
• Analyze and report the impact of federal and state Medicare/Medicaid regulatory changes, and develop responses if needed.
• Conduct audits of each communities EHR/documentation systems, Clinical Dashboard review -care plan reviews, incomplete (overdue and due) care plans, diagnosis notifications, change in condition alerts and point of care completion, Baseline Care Plans, UDA's - for potential Healthcare Systems of America opportunities.
• Coordinates communication with the contracting department on payer related issues preventing the timely collection of revenue.
• Implementing a system to ensure that accurate billing information is entered into the billing system.
• Supervising the reimbursement by performing various duties, such as account management, communications with insurance providers, collections, cash posting, contract analysis, and billing.
• Managing staff performance by providing regular feedback, performance reviews, and one-on-one meetings.
• Reviewing financial hardship applications.
• Planning and structuring the department workflow and staffing.
• Correctly coding diagnoses and procedures.
• Responsible for staff education and training related to software program changes and upgrades.
• Ensures effective communication among team members, operations, finance, clinical, and support staff.
• Demonstrates knowledge of software systems to support the AR and accounting team.
• Participates in the due diligence of acquisitions and integration of a newly acquired company.
• Performs monthly review of outstanding AR, cash reconciliation and DSO trends with management team.
• Maintains confidentiality and privacy of patient/family finances, records, health status, etc.
• Demonstrates ability to solve problems independently and perform at optimal level.
• Assists with the development and management of statistical and financial data tracking methodology and reporting for the skilled business.
  
  

EXPERIENCE/EDUCATION REQUIREMENTS

• Bachelor's degree in finance, business administration, healthcare administration, or related field.
• At least 5 years experience in healthcare billing.
• Experience in the Florida market preferred.

SKILLS/REQUIREMENTS

• Proficient in all Microsoft Office applications as well as medical office software.
• Sound knowledge of health insurance providers.
• Strong interpersonal and organizational skills.
• Excellent customer service skills.
• The ability to work in a fast-paced environment.