Job Description

Iredell Physician Network is currently looking for an experienced Physician Network Revenue Cycle Director to provide leadership and strategic direction; to optimize revenue cycle operations; and maximize collections and claims revenue; and, improve financial health while ensuring compliance.

The successful candidate will engage by developing and implementing strategies, leading cross-functional teams, optimizing processes from patient registration to collections, and ensuring the organization adheres to all relevant regulations.

This position is also responsible for identifying and implementing technology solutions, analyzing performance metrics, and collaborating with other leaders to achieve financial goals. Completes all duties while respecting patient confidentiality and promoting the mission, vision and values of the organization.

ESSENTIAL FUNCTIONS

• Develops and executes the organization's overall revenue cycle strategy to align with its financial objectives.
• Collaborates with executive leaders, clinical operations leaders and external stakeholders to align billing strategies with broader business objectives.
• Maximizes revenue by optimizing collections, reducing inefficiencies and gaps, and implementing cost-saving initiatives. Tracks and reports monthly Accounts Receivable KPI’s.
• Manages day-to-day Central Billing Office and Revenue Integrity operations to ensure accuracy and efficiency in processes like patient registration, billing, charge capture, coding, claims submission, remittance processing, denial management, collections, and resolution of payment variances to secure maximum reimbursement.
• Drives continuous improvement, provides performance feedback, and achieves strategic goals.
• Provides ongoing support and training to staff to meet the expectations established for high quality patient service, payer relations, billing and regulatory compliance, and other established guidelines.
• Works to create transparent, patient-friendly billing processes.
• Ensures strict adherence to State, Federal and Payer regulations, industry standards and company policies to mitigate penalties and legal risks.
• Stays informed about industry trends and regulatory changes affecting billing and reimbursement.
• Analyzes payer reimbursement and claim denial patterns to identify opportunities for revenue enhancement.
• Analyzes revenue cycle processes and performance metrics to identify areas of improvement. Evaluates and implements technology solutions to enhance performance.
• Leads collaboration with payers to resolve escalated issues, streamline processes, and ensure compliance with contract terms, reimbursement policies, and regulatory requirements. Collaborates with the organization’s financial service functions to ensure accurate and efficient recording of information and compliance with established financials controls.
• Participates in processes to review, analyze, and negotiate contracts with third party payers to promote optimal collections and efficient billing and collections processes.
• Oversees the Revenue Cycle annual capital and operating budgets, monitors expenses, and continually seeks cost-effective process improvement to enhance performance.
• Leads the development and implementation of revenue specific policies, procedures, and programs and monitors adherence to system-wide policies/standardizations.
• Works closely with Oracle Business Systems Analysts to maximize practice management system performance and other revenue cycle vendor performance, and test and implement new applications, releases and upgrades.
• 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.

Requirements

Education and Experience

Required:

• Bachelor’s degree in Healthcare Administration, Business, or related field.
• Five (5) or more years of senior-level revenue cycle management experience in a provider practice medical system or group.
• Demonstrated competence in all areas of revenue cycle operations, including clinic business office and billing and collections in the healthcare industry.

Knowledge, Skills and Abilities

• Knowledge of and experience in the operational aspects of physician office practice.
• Demonstrable knowledge of the requirements of coding patient encounters with physicians and skill in applying that knowledge.
• Demonstrable knowledge of Medicare regulations relating to claims preparation and processing.
• Demonstrated analytical skills in healthcare reimbursement and ability to use data to drive process improvement.
• Demonstrated skill in the effective use of practice management systems in improving revenue cycle functions.
• Ability to engage others, listen and adapt response to meet others’ needs.
• Excellent computer and keyboarding skills, including familiarity with Windows and strong Excel skills.
• Excellent verbal and written communication and presentation skills.
• Ability to manage competing priorities.
• Ability to perform job duties in a professional manner at all times.
• Ability to understand, recall, and communicate, factual information.
• Ability to align group’s priorities and activities to the strategic goals of the company.
• Ability to anticipate, communicate, and encourage employee involvement in needed change initiatives and develop the high-impact skills for all team members.
• High degree of independence, flexibility, initiative and commitment
• Ability to apply standardized processes appropriately; continuously improving processes.
• The ability to establish functional, collaborative, and cooperative relationships with operational and administrative management.
• Knowledge of financial reporting concepts and preferred business practices.
• Skill in analyzing and interpreting financial records.