Director of Revenue Cycle Management
Cenevia Health Business Services, Richmond Heights, Virginia, United States
At Cenevia, we eliminate operational burdens so our healthcare delivery champions can focus on providing high-quality and cost-effective health outcomes. Since 1996, Cenevia has been a trusted support system, training partner and business process expert for health providers, including Federally Qualified Health Centers (FQHC), private practices, hospitals, managed care organizations, and provider networks.
Cenevia provides integrated, network-based services and programs to healthcare clients to help them run their businesses better so that they can focus on patient care. This includes the centralized practice management system, help desk, and support infrastructure that Cenevia established in 1999.
The Cenevia staff includes experienced health care professionals from the following areas:
Revenue Cycle Management Quality Improvement Health Information Technology Health Plan Contracting Credentialing and Enrollment (NCQA-certified) Summary/Objective:
This position is primarily responsible for planning, directing and administration of the Central Business Office by performing the following duties. This role is exempt from the overtime and minimum wage provisions of the Fair Labor Standards Act under the Executive exemption test. This position's primary duties are managing a customarily recognized department of Cenevia and the employee customarily and regularly directs the work of at least two or more other full-time employees or their equivalent and has the authority to hire and terminate other employees or the employee's suggestions and recommendations as to the hiring, termination, advancement, promotion or any other change of status of other employees are given particular weight when those decisions are being made.
Essential Functions:
Core duties and responsibilities include the following. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.
Manages Revenue Cycle Management ("RCM") process including, but not limited to billing, collections, cash posting, refund, and End of Month. Proficient in all areas of RCM lifecycle and capable of aiding where needed with medical and dental billing processes and running and analyzing system reports. Leads changes in systems, people, and operational processes to achieve industry-leading results. Monitors and analyzes RCM KPI's through running and analyzing reports and identifies and resolves issues that are impacting operational results. Achieves improved administrative processes and efficiencies to increase cash flow, reduce accounts receivable days outstanding, increase collections and enhanced billing accuracy to minimize payor rejections or denials. Effectively leads and retains departmental staff by fostering a team environment, engagement, buy in, defined roles and responsibilities, operational improvements/efficiencies, monitoring staffing ratios, SMART goals, and professional development as well as through leading with accountability, empathy, responsiveness, and seasoned RCM KSAs. Ensures equity across team workloads and monitoring production metrics to support productivity goals and development. Serves as internal and external client liaison for industry information, software configuration and best practices as well as point of contact for internal and external client related RCM inquiries. Provides timely notification of industry and payor changes which impact client revenue and RCM processes and communicates changes to internal and external clients. Provides staff with direction and leadership on RCM related client matters (i.e., when to adjust uncollectable claims for revenue cycle clean up.) Maintains knowledge of governmental and private payer payment methodologies and analyzes, troubleshoots, and measures performance for processes affecting the revenue cycle and identifies and communicates payor issues internally and externally. Reviews departmental budget variances and revenue streams and forecasts revenue projections based upon current and projected staffing, department operation models, billable services, payer reimbursements, and business development opportunities and communicates this information regularly with leadership. Ensures that department activities comply with current industry practices and regulatory requirements relating to RCM. Ensures internal departmental compliance with company policies, contracts, processes, SOC controls, and performs recurring audits to ensure same. Administers web sites for insurance companies: password procurement and password termination, add new providers for data access to existing websites. Problem solves for complex billing issues and generates supporting reports and analytics illustrating same, including EDI and EFT/ERA issues. Demonstrates responsiveness and professionalism by providing timely and effective communication to the CEO, ensuring prompt attention to requests, inquiries and directives as required. Ability to foster cooperative and effective as well as continuous positive working relationships with the executive team, Board of Directors, business/community associates and other health care facilities and organizations. Provides reports on most recent outstanding A/R and A/R trends to CEO and executive committee monthly. QUALIFICATIONS:
Bachelor's degree (B.A.) from four-year college or university in healthcare management; eight to ten plus years related experience and/or training; or equivalent combination of education and experience. Certified Professional Coder (CPC) Certified Professional Biller (CPB) Other Skills and Abilities:
Strong leadership experience leading and developing large teams of people towards increased morale, engagement, productivity, and positive outcomes. Supportive of and accountable to staff. Ability work across billing departments to assure equity and fairness. Ability to perform revenue cycle management functions. eCW and EPIC proficiency. Waystar experience preferred. Federally Qualified Health Center ("FQHC") experience preferred. Knowledge of dental and medical RCM process, billing, coding, and auditing. Knowledge of various clearinghouses. Familiarity with CMS and other payors as well as payor rules specific to FQHCs. Strong Excel experience. Strong problem-solving skills with the ability to diagnose problems and identify and implement solutions. Exemplary communication and interpersonal skills. Strong decision-making skills. Time management, prioritization, and multitasking capabilities. Willingness and expertise to assist team as needed with RCM lifecycle processes and reports Results driven, accountable, and responsive. Demonstrated experience developing and maintaining effective working relationships across the organization. SUPERVISORY RESPONSIBILITIES:
Manages supervisors that oversee the employees in the billing department's day to day workflow. Responsible for the overall direction, coordination, and evaluation while utilizing sound and fair judgment of each employee. Carries out managerial responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include, but not limited to, interviewing, hiring, and training employees; planning, assigning, and directing work.
COMPETENCIES:
To perform the job successfully, an individual should demonstrate the following competencies:
Business Acumen
- Understands business implications of decisions; displays orientation to profitability; demonstrates knowledge of market and competition; aligns work with strategic goals. Client Focus
- Anticipating, understanding, and fulfilling customer needs and expectations by providing excellent direct and indirect service. Communication
- Conveying and receiving information and ideas efficiently and effectively through a variety of organizational mediums. Initiative
- Seeking new/additional responsibilities, projects, tasks; Acting independently in new/routine situations. PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to stand and walk.
The employee must occasionally lift and/or move up to 10 pounds.
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
The noise level in the work environment is usually moderate.
Cenevia is an equal opportunity employer.
At Cenevia, we believe diversity brings strength and adaptability by drawing on a broad range of talents, experiences and perspectives, and affords an inclusive workplace and culture where all people, regardless of gender, race, ethnicity, sexual orientation, or background, feel a sense of belonging.
This position is remote, and employee must have suitable and secure technology to be eligible for consideration - e.g., secure Wi-Fi, telephone, dedicated workspace. Additionally, employee is required to participate and be seen in meetings via video conference as part of this role.
Benefits Offered:
Simple IRA Matching Health Insurance Paid Time Off Paid Holidays Dental Insurance Vision Insurance Life Insurance Employee Assistance Program Tuition Reimbursement Disability insurance Fitness Program
Cenevia provides integrated, network-based services and programs to healthcare clients to help them run their businesses better so that they can focus on patient care. This includes the centralized practice management system, help desk, and support infrastructure that Cenevia established in 1999.
The Cenevia staff includes experienced health care professionals from the following areas:
Revenue Cycle Management Quality Improvement Health Information Technology Health Plan Contracting Credentialing and Enrollment (NCQA-certified) Summary/Objective:
This position is primarily responsible for planning, directing and administration of the Central Business Office by performing the following duties. This role is exempt from the overtime and minimum wage provisions of the Fair Labor Standards Act under the Executive exemption test. This position's primary duties are managing a customarily recognized department of Cenevia and the employee customarily and regularly directs the work of at least two or more other full-time employees or their equivalent and has the authority to hire and terminate other employees or the employee's suggestions and recommendations as to the hiring, termination, advancement, promotion or any other change of status of other employees are given particular weight when those decisions are being made.
Essential Functions:
Core duties and responsibilities include the following. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.
Manages Revenue Cycle Management ("RCM") process including, but not limited to billing, collections, cash posting, refund, and End of Month. Proficient in all areas of RCM lifecycle and capable of aiding where needed with medical and dental billing processes and running and analyzing system reports. Leads changes in systems, people, and operational processes to achieve industry-leading results. Monitors and analyzes RCM KPI's through running and analyzing reports and identifies and resolves issues that are impacting operational results. Achieves improved administrative processes and efficiencies to increase cash flow, reduce accounts receivable days outstanding, increase collections and enhanced billing accuracy to minimize payor rejections or denials. Effectively leads and retains departmental staff by fostering a team environment, engagement, buy in, defined roles and responsibilities, operational improvements/efficiencies, monitoring staffing ratios, SMART goals, and professional development as well as through leading with accountability, empathy, responsiveness, and seasoned RCM KSAs. Ensures equity across team workloads and monitoring production metrics to support productivity goals and development. Serves as internal and external client liaison for industry information, software configuration and best practices as well as point of contact for internal and external client related RCM inquiries. Provides timely notification of industry and payor changes which impact client revenue and RCM processes and communicates changes to internal and external clients. Provides staff with direction and leadership on RCM related client matters (i.e., when to adjust uncollectable claims for revenue cycle clean up.) Maintains knowledge of governmental and private payer payment methodologies and analyzes, troubleshoots, and measures performance for processes affecting the revenue cycle and identifies and communicates payor issues internally and externally. Reviews departmental budget variances and revenue streams and forecasts revenue projections based upon current and projected staffing, department operation models, billable services, payer reimbursements, and business development opportunities and communicates this information regularly with leadership. Ensures that department activities comply with current industry practices and regulatory requirements relating to RCM. Ensures internal departmental compliance with company policies, contracts, processes, SOC controls, and performs recurring audits to ensure same. Administers web sites for insurance companies: password procurement and password termination, add new providers for data access to existing websites. Problem solves for complex billing issues and generates supporting reports and analytics illustrating same, including EDI and EFT/ERA issues. Demonstrates responsiveness and professionalism by providing timely and effective communication to the CEO, ensuring prompt attention to requests, inquiries and directives as required. Ability to foster cooperative and effective as well as continuous positive working relationships with the executive team, Board of Directors, business/community associates and other health care facilities and organizations. Provides reports on most recent outstanding A/R and A/R trends to CEO and executive committee monthly. QUALIFICATIONS:
Bachelor's degree (B.A.) from four-year college or university in healthcare management; eight to ten plus years related experience and/or training; or equivalent combination of education and experience. Certified Professional Coder (CPC) Certified Professional Biller (CPB) Other Skills and Abilities:
Strong leadership experience leading and developing large teams of people towards increased morale, engagement, productivity, and positive outcomes. Supportive of and accountable to staff. Ability work across billing departments to assure equity and fairness. Ability to perform revenue cycle management functions. eCW and EPIC proficiency. Waystar experience preferred. Federally Qualified Health Center ("FQHC") experience preferred. Knowledge of dental and medical RCM process, billing, coding, and auditing. Knowledge of various clearinghouses. Familiarity with CMS and other payors as well as payor rules specific to FQHCs. Strong Excel experience. Strong problem-solving skills with the ability to diagnose problems and identify and implement solutions. Exemplary communication and interpersonal skills. Strong decision-making skills. Time management, prioritization, and multitasking capabilities. Willingness and expertise to assist team as needed with RCM lifecycle processes and reports Results driven, accountable, and responsive. Demonstrated experience developing and maintaining effective working relationships across the organization. SUPERVISORY RESPONSIBILITIES:
Manages supervisors that oversee the employees in the billing department's day to day workflow. Responsible for the overall direction, coordination, and evaluation while utilizing sound and fair judgment of each employee. Carries out managerial responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include, but not limited to, interviewing, hiring, and training employees; planning, assigning, and directing work.
COMPETENCIES:
To perform the job successfully, an individual should demonstrate the following competencies:
Business Acumen
- Understands business implications of decisions; displays orientation to profitability; demonstrates knowledge of market and competition; aligns work with strategic goals. Client Focus
- Anticipating, understanding, and fulfilling customer needs and expectations by providing excellent direct and indirect service. Communication
- Conveying and receiving information and ideas efficiently and effectively through a variety of organizational mediums. Initiative
- Seeking new/additional responsibilities, projects, tasks; Acting independently in new/routine situations. PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to stand and walk.
The employee must occasionally lift and/or move up to 10 pounds.
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
The noise level in the work environment is usually moderate.
Cenevia is an equal opportunity employer.
At Cenevia, we believe diversity brings strength and adaptability by drawing on a broad range of talents, experiences and perspectives, and affords an inclusive workplace and culture where all people, regardless of gender, race, ethnicity, sexual orientation, or background, feel a sense of belonging.
This position is remote, and employee must have suitable and secure technology to be eligible for consideration - e.g., secure Wi-Fi, telephone, dedicated workspace. Additionally, employee is required to participate and be seen in meetings via video conference as part of this role.
Benefits Offered:
Simple IRA Matching Health Insurance Paid Time Off Paid Holidays Dental Insurance Vision Insurance Life Insurance Employee Assistance Program Tuition Reimbursement Disability insurance Fitness Program