Revenue Cycle Director directs and oversees the overall policies, objectives, and initiatives of an organization's revenue cycle activities to optimize the patient financial interaction along the care continuum. Reviews, designs, and implements processes surrounding admissions, pricing, billing, third party payer relationships, compliance, collections, and other financial analyses to ensure that clinical revenue cycle is effective and properly utilized. Being a Revenue Cycle Director tracks numerous metrics related to the patient engagement cycle including record coding error rates and billing turnaround times to develop sound revenue cycle analysis and reporting. Manages relations with payers and providers to generate high reimbursement rates and a low level of denials. Additionally, Revenue Cycle Director requires a bachelor's degree. Typically reports to top management. The Revenue Cycle Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Revenue Cycle Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)
This position is remote, but candidate must reside in Hawai’i
As a Lead Revenue Cycle Specialist, you will play a crucial role in managing the revenue cycle operations of our healthcare facility, with a focus on medical billing front end and insurance collections. This position requires strong expertise in claims processing, insurance collections, and leadership skills.
Responsibilities:
Medical Billing Front End:
Process 100 accounts per day for claims processing, focusing on Hospital/Acute billing
Handle both electronic and paper claims submissions, ensuring accuracy and compliance.
Manage a work queue comprising 75% corrections and front-end denials, including 277 rejections.
Utilize payer portals for claim submissions and corrections.
Address front-end denials promptly, ensuring timely resolution.
Insurance Collections:
Handle 50 accounts per day for insurance collections, focusing on post-billing stages.
Verify claim status and perform follow-up actions, utilizing payer portals effectively.
Process deferrals and resubmissions, addressing back-end denials through thorough research and resolution.
Collaborate with the Utilization Management team to address complex claims and payer issues.
Utilize government payer experience, including Medicare and Medicaid, to navigate reimbursement processes effectively.
Requirements:
Demonstrated experience in medical billing front end and insurance collections, with a strong understanding of Hospital/Acute billing processes.
Proficiency in handling both electronic and paper claims submissions.
Ability to manage high-volume work queues and prioritize tasks effectively.
Experience with payer portals and claim status verification.
Strong problem-solving skills and attention to detail, especially in resolving denials and rejections.
Prior leadership experience in revenue cycle management.
EPIC software, preferred not required
Familiarity with government payers, including Medicare and Medicaid, is highly desirable.
Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal teams and external stakeholders.
This position is remote, but candidate must reside in Hawai’i