Job Description

POSITION SUMMARY

This position is responsible for applying professional knowledge to analyze financial information across all aspects of the patient revenue cycle and for preparing a wide range of monthly, quarterly, and annual financial reports, including those required for regulatory compliance. The role also includes maintaining master files and billing fee schedules.

REPORTING RELATIONSHIPS

The position reports to the VP of Revenue Cycle

ESSENTIAL JOB DUTIES AND FUNCTIONS

While living and demonstrating our Core Values, the Director of Revenue Analytics, Reporting, & Strategy will:

• Work collaboratively with the VP of Revenue Cycle to facilitate reporting requirements for the monthly TWC – Revenue Cycle Management Dashboard creation.
• Responsible for creation and analysis of monthly productivity reports outlining visits, receipts, and charges per provider in conjunction with the VP of Revenue Cycle.
• Working with VP of Revenue Cycle, ensure the appropriate information is maintained and reconciled to the general ledger to record, measure, value and report on patient service revenue, receivables and related collections and allowances.
• Streamline month-end Medent reports used by the billing team to address claim rejections and accounts receivable.
• Responsible for preparing and submitting monthly visit data reports and VTO metrics to the Finance department.
• Assist the VP of Revenue Cycle in preparing regulatory reports, including the annual Medicare Cost Report, UDS visit measures, Medicaid Wrap-Around report, and other required submissions.
• Responsible for annual maintenance of billing fee schedule for determination of consistency with local pricing based on Optum’s suggested pricing guidelines for locality.
• Responsible for maintenance of CPT codes, including adding, updating and deleting codes annually based on current AMA/insurance guidelines.
• Responsible for maintenance of CPT, Insurance, and Provider Master File setup in conjunction with the EHR team.
• Responsible for maintenance of other Master Files as assigned.
• Coordinate with the enrollment team on new provider setups to ensure proper release of insurance claims from the Medent system.
• Manage outstanding accounts receivable. Parties which may be contacted to resolve an outstanding balance include but are not limited to patients, responsible parties, insurance carriers, case managers, employers, referring physician, attorneys and facility personnel
• Make all necessary corrections in the billing system. Research and resolve claims rejected by payer. Decide if accounts can’t be paid by the insurance company and summarize for review with the VP Controller Revenue cycle.
• Identify billing and coverage concerns. Communicate with billing and front office staff regarding billing requirements not being met
• Answer patient and facility questions about account balance and status of payment. Decide if patient balance is refusal to pay or inability to pay, so the account can be added to a fee waiver request by the VP Controller Revenue Cycle)
• Responsible for triaging workload and prioritizing tasks through proper utilization of staff resources
• Identify, correct and communicate facility errors to appropriate parties involved and produce corrective action plans accordingly
• Identify and communicate payment trends to the Accounts Receivable & Collections Manager, related to payers, CPT codes, diagnosis codes, etc.
• Approve outstanding credit balances and requests for refunds
• Along with Director of Revenue Cycle, develop a strategy the team will use to reach goals and maintain high level of productivity
• Create reports to update the organization on Billing Department progress
• Develops policies and procedures regarding all front-end revenue cycle processes including insurances, copay collection, payment plans, Sliding Fee, Outreach and Enrollment
• Develop trainings to ensure proper co-pay collection at the level of the front desk. Further, partner with operational leadership to develop co-pay collection accountability
• Works closely with the credentialing team to ensure targets are met for providers to meet timely filing and reduce the rate of claim rejections
• Meets with payor representatives and is knowledgeable of contractual agreements with regards to reimbursement models
• Serve as Billing Department representative at clinical huddles, didactics and other clinical meetings
• Serve as Billing Department representative at monthly, organizational-wide Department Compliance meetings
• Assist with special project reporting out of the Medent system, by gathering the data in excel and manipulating it for its specific use.
• Perform special projects and other duties as assigned.

Requirements

• Meet The Wright Center for Community Health and its affiliated entity The Wright Center for Graduate Medical Education EOS© People Analyzer Tool
• Buy in and experience working in the EOS® model (strongly preferred)
• Mission-oriented; represents the enterprise in a professional manner while demonstrating organizational pride
• Bachelor’s Degree in Business or a related field, or equivalent experience
• Experience in patient billing highly desirable
• 5 - 7 years of progressively responsible experience required
• Project management experience preferred
• Demonstrate ability to establish work priorities, delegate assignments as appropriate and follow through to ensure completion of activities
• Strong computer aptitude and proficiency, including advanced Excel skills such as V-lookups, Pivot Tables, etc.; proficiency in other MS Office applications a must
• Demonstrate success in leveraging financial system capabilities
• Excellent data management and analytical skills with a passion for details and “digging in”
• Strong organizational skills and ability to balance multiple priorities with superior attention to detail in a dynamic environment; ability to drive process improvements
• Must have excellent work habits, including a willingness to work the hours necessary to get the job done, especially when important deadlines cause greater than normal departmental pressures
• Highly motivated with a drive to succeed