Job Description

ABOUT AUSTIN REGIONAL CLINIC

Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 15 years! We are one of central Texas’ largest professional medical groups with 35+ locations and we are continuing to grow. We offer the following benefits to eligible team members: Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more. For additional information visit https://www.austinregionalclinic.com/careers/

PURPOSE

The Billing & Revenue Integrity Director is responsible for ensuring that patient encounters are accurately and completely translated into clean claims for timely submission to payers. This position provides leadership and oversight for billing operations and revenue integrity activities. The Director is responsible for the Professional Billing (PB) and Revenue Integrity processes which includes a focus on charges, reducing billing errors, and improving daily revenue flow for clinician services. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

ESSENTIAL FUNCTIONS

• Directs the organization’s Professional Billing and Revenue Integrity functions.
• Provides leadership and oversight for all operational workflows required to move completed patient encounters to accurate initial claim submission.
• Oversees Billing & Revenue Integrity operations through direct supervision of managers and supervisors. Holds managers and their staff accountable for achieving stated objectives.
• Works effectively with leaders to develop and implement consistent, sustainable business processes.
• Through the managers ensures competency of staff through development and regular evaluations.
• Ensures claims are generated and submitted accurately, completely, and timely in accordance with organization standards and payer requirements.
• Monitors encounters that have not progressed to billing and ensures appropriate follow-up and resolution.
• Establishes clear accountability for unresolved encounters, billing holds, edits, and work queues.
• Maintains appropriate controls to prevent encounters from remaining unbilled or unresolved beyond established thresholds.
• Ensures appropriate escalation processes exist for complex or aging billing issues.
• Oversees charge review work queues designed to identify incomplete, inconsistent, missing, duplicate, or potentially inaccurate charges before claim submission.
• Establishes standardized processes for researching and resolving charge review edits.
• Oversees reconciliation processes designed to identify encounters, procedures, supplies, medications, diagnostic services, or other billable activity that many have not been appropriately captured.
• Assists the organization in denial management by analyzing root causes for rejected and denied insurance claims to propose process improvements.
• Develops full-scale project plans and related communication documents, project post mortems, and creates a recommendations report in order to identify successful and unsuccessful project elements.
• Develops best practices and tools for project execution and management.
• Responsible for the implementation of department-specific goals and objectives consistent with the organization’s strategic plan and goals and industry benchmarks.
• Collaborates with departments throughout the company to streamline procedures related to the revenue cycle process to achieve the effectiveness, efficiency, compliance and accuracy of the billing effort.
• Communicates regularly with others about department progress toward goal achievement, critical factors, and obstacles.
• Sets and continually manages department expectations with team members and other teams.
• Determines the frequency and content of status reports from the department, analyzes results, and troubleshoots problem areas.
• Participates in system upgrade planning and implementation.
• Coordinates resources with other teams and departments in the organization.
• Leads and/or attends meetings, participates in workgroups and/or serves on committees.
• Ensures internal controls are maintained to reduce the potential for error.
• Demonstrates concern and respect for others in all interactions and inspires confidence and trust.
• Promotes long term financial stability and sustainable growth to safeguard our ability to continue to offer high quality, coordinated care.
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Regular and dependable attendance.
• Follow the core competencies set forth by the organization, which are available for review on ARC SharePoint.

OTHER DUTIES AND RESPONSIBILITIES

• Performs other duties as assigned.

QUALIFICATIONS

Education and Experience

Required:

• Bachelor’s Degree in Healthcare Administration, Finance, or related field and four (4) or more years of experience in a multi-specialty medical group, to include at least three (3) years supervision of staff, or
• High school diploma or equivalent and eight (8) or more years of experience in a multi-specialty medical group, to include at least three (3) years supervision of staff.
• Proven proficiency in financial management, which includes comprehensive understanding of insurance plans as they relate to physician practice.

Preferred: Experience working in an organization that utilizes Epic. Experience working in both an outpatient clinical setting and familiarity with surgical specialty practices and their outside relationships.

Certificate/License

Certification from AAPC (CPC) or AHIMA (RHIA), preferred.

Knowledge, Skills and Abilities

• Proven ability to lead teams, including building cross functional teams.
• In-depth knowledge and understanding of healthcare services, insurance and billing practices, procedural and diagnostic coding.
• Deep expertise in CPT, HCPCS, and ICD-10 codes.
• Broad knowledge of application integration and data flow.
• Exposure and working knowledge of Epic strongly preferred.
• Proficient computer skills and knowledge of Microsoft Excel.
• Ability to hire, develop, and retain best talent through competency-based hiring and selection, career development, and motivational strategies.
• Skill and ability to translate visionary concepts into well defined, documented technical requirements and present them to senior leadership.
• Ability to engage others, listen and adapt response to meet others’ needs.
• Ability to align own actions with those of other team members committed to common goals.
• Excellent verbal and written communication skills.
• Ability to manage competing priorities.
• Ability to perform job duties in a professional manner at all times.
• Ability to understand opposing points of view on highly complex issues and to negotiate and integrate different viewpoints.
• Ability to make decisions which have significant impact on the department's credibility, operations, and services.
• Ability to understand, recall, and communicate factual information.
• Ability to understand, recall, and apply oral and/or written instructions or other information.
• Ability to organize thoughts and ideas into understandable terminology.
• Ability to apply common sense in performing job.
• Strong organizational and analytical skills with attention to detail.
• Ability to present in front of groups and lead discussions.
• Excellent problem-solving skills.
• Ability to produce quality outcomes within tight timeframes.