Job Details

Manages the policies, objectives, and initiatives of the organization's revenue cycle activities to achieve operational goals and cash flow targets. Implements processes and procedures to optimize the revenue cycle and ensure compliance.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Establish and monitor systems for collection of claims data, processing claims, and reporting functions related to fee-for-service billing.
• Recruits, trains, and supervises billing staff.
• Ensures that collections are maximized.
• Functions as liaison to the provider relations department of the payors.
• Serves as liaison to Practice Management application vendors around claims processing and financial reporting.
• Works with the finance department to ensure accurate and relevant reporting.
• Collaborates with AVP of Finance around issues related to revenue reports and claims processing for annual audit.
• Manage Agency EIM/ESM Virtual Gateway.
• In conjunction with IT staff, manage PM Software maintenance and upgrades.
• Complete and maintain documentation as required by applicable funding or regulatory agencies.
• Maintain compliance with all policies and procedures.
• Ensure billing compliance with relevant MA and Rhode Island state regulations including Medicaid, with federal Medicare regulations as well as requirements of insurers.
• Participate in professional development activities and training necessary to maintain and enhance skills.
• Other duties as assigned.

Staff Management and Development:

• Assist with the screening of candidates for fit and recommend candidates for hire.
• Accountable for mentoring new employees, ensuring they receive appropriate training, and outlining professional development goals.
• Complete timely performance reviews and competencies, retain talented staff, and minimize turnover.
• Monitor staff performance, address concerns, develop PIPs, support staff, and recognize good performance.
• Ensure agency and department P&Ps are consistently applied.
• Complete all trainings, certifications, re-credentialing, and licensing renewals on time.

Leadership Responsibilities:

Director: Execute plans from the executive level, supervise managers and staff, establish procedures and standards, interpret policies, and ensure understanding of overall goals. Provide guidance, develop P&Ps, ensure compliance, and meet financial targets. Moderate to high flexibility required.

Supervision and Decision-Making:

Develops objectives independently, making important decisions with little guidance based on established P&Ps.

Qualifications:

• Education: BA, MA preferred
• Work Experience: 5+ years overseeing billing functions in healthcare
• Licensing: None
• Certifications: CPC preferred

Knowledge, Skills & Abilities:

• Proficiency in medical billing codes (CPT, ICD-10, HCPCS)
• Knowledge of Microsoft Excel and other Microsoft applications
• Knowledge of third-party requirements, Medicare/Medicaid regulations, and electronic filing
• Thorough knowledge of medical and physician billing

• Strong organizational skills and attention to detail
• Excellent communication, leadership, and critical thinking skills
• Maintains strict confidentiality adhering to all HIPAA & 42 CFR regulations