Director, Physician Revenue Management

The Director, Physician Revenue Management is responsible for the proper management and organization of the billing and accounts receivables management and all related functions within the scope of the incumbent purview.

Directs, plans, and organizes revenue cycle activities for the Health System. Provides oversight of business process improvement, quality auditing and training as well as revenue cycle project management to include processes for 3000 billing providers and growing, as well as strategy in preparation for continued acquisition and growth with all new providers onboarded with Orlando Health/Bayfront Health physician groups, and any/all forthcoming provider groups.

• Oversight of Revenue Management functions within their purview for 3,000 employed providers.

• Oversight of Revenue Management functions within their purview for any new physician acquisitions and/or transitional services agreements implemented.

• Develops, schedules, and monitors all department operations, and develops suggestions to improve the department operations including systems to ensure all encounters at both the health centers and hospitals are captured and billed.

• Monitors adjustments and write-offs to ensure adequate collection efforts are made.

• Develops yearly capital budgets and staffing ratios.

• Monitors and identifies equipment needs and maintains supplies at adequate levels.

• Educates other staff members on release of confidential information laws to individuals and third party carriers.

• Trains staff in all pertinent management areas in their purview of responsibility.

• Performs orientation of new employees and in-services to update staff as needed on the proper procedures for the identification of prime, nonprime, other commercial contracts, Medicaid, Medicare, Motor Vehicle and Workers’ Compensation billing arrangements.

• Researches all insurance/injury questions and/or problems that require access to medical records.

• Educates staff to efficiently review medical records for accident details and all other insurance problems.

• Promotes good customer/patient service by ensuring that customer/patient’s questions and/or problems are researched and resolved in a timely, courteous, and appropriate manner.

• Meets regularly and develops a good relationship with the Business Managers.

• Maintains and monitors claims aging schedule, and takes corrective action when necessary, to include ensuring contractual adjustments are made and balances do not represent unattached benefits.

• Monitors provider performance through procedural code analysis and provides statistics comparing them to Industry Data to identify outliers.

• Keeps and monitors performance statistics regarding each department member and compares them to established staffing ratios and takes corrective action when necessary.

• Ensures that duties among billing staff are equally distributed.

• Prepares and gives employee performance evaluations as appropriate.

• Implements the strategic goals and objectives of the Revenue Management department.

• Establishes the internal controls for revenue cycle compliance.

• Maintains up-to-date knowledge, training, and expertise of the healthcare industry rules and regulations and developments necessary to perform their functions.

• Develop, schedule, and monitor all departmental operations.

• Identify improvements for departmental operations utilizing people, process, and technology to ensure charge capture, billing, coding and payment posting activities are performed.

• Monitor adjustments and write offs to ensure proper and accurate account adjudication is performed.

• Ensures yearly budget and employee hiring activities are met.

• Create and provide regular operational metric reporting to the Senior Director.

• Develops the structure of billing arrangements for new contracts and monitors existing contracts in the billing system to ensure accurate billing rates and completeness of items billed.

• Educate and train team members within the organization on all aspects of Revenue Cycle as necessary.

• Performs orientation of new employees and in-services. Updating team members on contracts and payor guidelines for all major commercial insurance plans as well as government insurance plans, amongst others.

• Research escalated insurance, coding and payment inquiries.

• Promotes quality customer/patient service by ensuring that questions or issues are resolved effectively in a timely, courteous and appropriate manner.

• Meets with operational leaders as appropriate to resolve any outstanding Revenue management concerns.

• Oversees the productivity statistics of Revenue Management team members and works closely with the management team to resolve any performance concerns.

• Periodically reviews staff job descriptions and updates as necessary.

• Keeps staff informed of changes/developments in the department as discussed in the monthly staff meetings and implements changes when necessary.

• Develops and documents policies and procedures pertaining to billing and collections processes from patient registration to payment posting and balance adjustments.

• Provides regular reports and analyses to the Senior Director to monitor billing, pending claims and collections.

• Manages various human resources functions including hiring, work assignments, coaching plans, and performance counseling.

• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.

• Maintains compliance with all Orlando Health policies and procedures.

Education / Training

• High school diploma required.

• Bachelor’s degree in business or healthcare administration/management preferred.

• 10 (ten) years of Healthcare Revenue Cycle experience may substitute for Bachelor’s degree requirement.

• A minimum of 3 years in Revenue Cycle Leadership required.

• PC skills in a Windows environment are required.

• Knowledge and utilization of desktop applications to include Word and Excel is essential.

• Innovative, motivated & able to lead by example.

• Excellent verbal and written communication skills.

• Ability to initiate and follow through on projects and work independently with minimal supervision required.