Job Description

Monterey Park Hospital, a 101-acute care facility in the San Gabriel Valley of Los Angeles County, is seeking a Full-Time Director of Revenue Cycle for our Managed Care Department. This position reports to the Chief Operating Officer.

Responsibilities

The Director, Revenue Cycle, is responsible for the coordination and overall management of the departmental workflow and technology within the Revenue Cycle. The Director, Revenue assures effective coordination of work processes and communication with Patient Financial Services, Admitting/Registration, Central Business Office, Health Information Management, clinical departments, Provider Medical Groups, Case Management, Denials Management, and IT. The Director, Revenue Cycle, establishes and ensures implementation of all revenue cycle policies and procedures. The Director of Revenue Cycle provides leadership, management, coaching, and strategy expertise to senior leadership and key department directors within Revenue Cycle. The Director of Revenue Cycle resolves escalated reimbursement issues with payors and regularly provides senior leadership with revenue cycle status, including reports and analysis. This position reports to the Chief Financial Officer or designee.

RESPONSIBILITIES:

• Responsible for provider reimbursement programs, policies and strategies to ensure unit cost controls meet or exceed objectives for medical cost data. Analyzes claims, utilization and medical cost data.
• Ensures account information contains accurate and comprehensive data to provide timely billing and optimal reimbursement for services.
• Establishes processes, metrics and monitoring systems to maximize reimbursement and cash collections.
• Assures effective coordination of work processes with Admitting/Registration, Health Information Management, Patient Accounting and clinical departments.
• Monitors aged accounts and verifies appropriate collection procedures are being followed.
• Regularly provides upper management with revenue cycle status including reports and analysis.
• Resolves escalated reimbursement issues with Payors.
• Monitors effectiveness of collection efforts and maintains insurance billing within established timeframes.
• Establishes and ensures implementation of all revenue cycle policies and procedures.
• Establishes positive business relationship with key physicians and medical groups. Initiates and facilitates new business development opportunities through proactive relations with affiliated IPAs.

Qualifications

• Bachelor’s Degree in Business Administration, Finance, Healthcare Administration, or related field or related experience required.
• Minimum 3 years hospital managed care experience required.
• Strong knowledge of medical insurance billing and collections with CPT, ICD-10, and DRG, coding, and medical terminology, as well as an understanding of managed care products required.
• Proficient in Microsoft Office