Director Of Revenue Cycle & Provider Enrollment

Position: Director ofRevenue Cycle & Provider Enrollment

Primary Location: Harwich Port/Remote/Hybrid Opportunity

Employment Status: Full-time, Salaried/Exempt

Reports To: Chief Financial Officer

Description Updated: November 2022

Summary/Objective

The Director of Revenue Cycle and Healthy Connections will oversee all aspects of Revenue Cycle, including billing, denials management, AR, coding and Provider Enrollment for Outer Cape Health Services (OCHS) patients. The incumbent will manage the patient account staff in the billing office and billing vendor ensure adequate staffing, training, performance, and overall patient encounter satisfaction.

Essential Functions

• Oversee billing and insurance aspects of the patient encounter from initial contact, insurance information assistance, and post-visit accounting and reimbursement functions including representation of OCHS with third-party payers, etc.
• Hire, orient and train staff for, patient accounts procedures in the billing office and Provider Enrollment. Arranges updated training as needed for policy or procedure changes.
• Coordinate training for staff in Epic or other patient-related software and conducts refresher classes as needed.
• Manages team performance level in accordance with departmental KPI's
• Drives operational and financial excellence of Revenue Cycle team
• Maintain current knowledge of practice management software and troubleshoot software-related issues with the appropriate vendor or OCHS IT staff.
• Work with site Directors to ensure registration and information gathering is complete and correct. Make suggestions to streamline the process.
• Prepare work schedules, makes job assignments and prepares and approves weekly payroll for all direct reports.
• Conduct staff performance reviews per OCHS policy. Recommend goals, objectives and performance standards for assigned areas. Collaborate with Human Resources and management in retention and recruitment efforts.
• Oversee subordinates' responses to billing-related inquiries from patients and resolves problems as authorized. Review delinquent accounts recommended for write-off for conformance with applicable collection policies.
• Oversee charge entry, claims processing, collections of receivables, application of cash, follow-up billing, and maintenance of related records and accounts. Ensure that this process is secure, accurate and timely and within acceptable accounting practice.
• Responsible for the enrollment of providers with payers
• Responsible for Medicare Credit Balance reports
• Responsible for provider education on coding changes and documentation updates
• Conduct month-end closings, collects and reports related data. May generate a variety of data reports as requested to support other OCHS functions.
• Review Charge Master and makes any recommendations to the CFO and prepares any changes for Board approval.
• Oversee and update any changes to the Health Safety Net Credit and Collections Policy as directed by HSN.
• Create and Maintain Monthly Revenue Cycle report package for CFO
• Maintain current knowledge of patient reimbursement changes affecting the Health Center's billing operation; monitors and evaluates departmental performance and takes corrective action as required.
• Collaborate with performance improvement staff to develop departmental quality assurance programs.
• Develop and implement improvement efforts as needed and contributes to the annual OCHS Performance Improvement Plan.
• Develop and maintain policies and procedures for all staff reporting to this position. Correlate such policies to directives of regulatory agencies such as DPH, JCAHO. Educate staff about new and existing policies, as well as location of policy manuals.
• Respond to auditor requests for reports/information needed during bi-annual audits.
• Emphasize and support outstanding customer service in all locations.
• Seek and apply customer service training materials as needed.
• Adhere to OCHS policies and procedures
• Other duties and projects as needed to fulfill the expectations of the position

Core Competencies

• Functional knowledge
  • Accounting principles
  • Financial management
  • Patient billing
  • Provider Enrollment
  • Medical Insurance, Billing and Coding
  • Insurance terms and Explanation of Benefits
  • Project management
  • Management
  • Computer skills
• Interaction and Collaboration
  • Strong interpersonal skills
  • Strengthening collaborative relationships

• Results and Detail-Oriented
  • Thoroughness
  • Accuracy
  • Attention to detail
• Communication
  • Excellent oral and written communication skills
  • Excellent telephone skills

• Self-Management/Personal Skills
  • Ethical
  • Self-direction
  • Detail-oriented
  • Dependability
  • Multi-tasking
  • Resourcefulness

Required Qualifications, Education, and Experience

• Minimum AA degree; BS or BA
• 3 5 years' management experience
• 3 5 years' of senior billing

Supervisory Duties

• Directly supervises the Patient Accounts Staff.

Physical and Mental Job Requirements

• Use of and/or subject to:
  • Vehicle
  • Light equipment
  • Computers/monitors
• Physical requirements:
  • Occasional lifting carrying up to 20lbs
  • Occasional bending
  • Occasional squatting
  • Occasional kneeling
  • Occasional reaching
  • Occasional standing
  • Frequent sitting
  • Occasional walking
  • Occasional fine motor control
  • Occasional finger dexterity
  • Frequent handwriting and typing
  • Occasional visual perception
  • Occasional visual inspection
  • Occasional hand/eye coordination
  • Frequent speaking
• Mental requirements:
  • Understand and apply routine verbal and/or written instructions
  • Understand and apply non-routine verbal and/or written instructions
  • Understand complex problems and collaborate to explore alternative solutions
  • Organize actions to complete sequential and/or routine tasks
  • Organize and prioritize individual work schedule to manage multiple patients, tasks, and/or projects
  • Organize and prioritize the work schedules of others to manage multiple patients, tasks and/or projects
  • Make decisions that have an impact on the individual's work
  • Make decisions that have an impact on the immediate work unit's operations and/or services
  • Make decisions that have significant impact on a department's credibility, operations, and/or services
  • Make decisions that have an impact on the health and wellbeing of patients
  • Communicate and exchange routine/basic information
  • Communicate and explain a variety of information
  • Communicate in-depth information for the purpose of interpreting, and/or negotiating
  • Communicate complex medical information to patients and patient families
  • Memorization/concentration
  • Learning/knowledge retention
  • Preparing/analyzing numerical figures
  • Analyzing/examining/testing data
  • Emotional/behavioral self-regulation
  • Interacting with others

Work Environment

• The functions of this role are conducted in an office environment.

Hours of Work

• This role is paid on a salaried basis.
• The hours of work for this position are:
• Typically, full-time salaried employees work 40 hours during a [Monday through Friday or Sunday through Saturday] workweek. However, this is a salaried position. Therefore, the individual is expected to work as required to complete the duties of the position. This may mean hours beyond 40 per week are required.

AAP/EEO Statement

Outer Cape Health Services is committed to a firm policy in favor of equal employment opportunity and will abide by all applicable state and federal regulations by not discriminating against any applicant or employee on the basis of race, religion, color, creed, sex, age, national origin, citizenship status, marital status, sexual orientation, gender identity and expression, disability or veteran status. Our commitment to equal employment opportunities shall include employment, upgrading, promotion, demotion, transfer, leaves or other absences from work, layoff, compensation and benefits, selection for training or other education, professional opportunities and conflict resolution.

It is also the policy of OCHS to take affirmative action to employ and to advance in employment, all persons regardless of their status as woman, minority or individuals with disabilities or protected veterans, and to base all employment decisions only on valid job requirements.

Please inform us of any necessary accommodations required during the application process and/or at any time during employment.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.