SUMMARY:
The Revenue Cycle Director is responsible for planning, directing and coordinating the direction and tactics for Spring Branch Community Health Center's reimbursement strategy. The Revenue Cycle Director oversees all revenue cycle operations including but not limited to call center, patient scheduling, eligibility, insurance verification, front desk, billing, collections and financial planning for patients. Additionally, this position requires the ability to engage in a collaborative manner with other departments including clinical, operations, finance, human resources, and credentialing to foster a positive and supportive environment. This position requires the ability to present billing activity reports in a clear and concise manner and works closely with the CFO to achieve metrics toward becoming a best-in-class health center.
QUALIFICATIONS:
- Bachelor's degree in health care administration or related field from an accredited university.
- Four years of health care revenue cycle experience, preferably in a federally qualified health center (FQHC) performing the essential duties and responsibilities as described below.
- Current knowledge of FQHC/medical office practices, procedures and billing program, Compliance, Fraud and Abuse rules as related to billing and collecting with Federal, State and third-party payers.
- Minimum of three years supervisory experience.
- Ability to analyze complex data, including fiscal and performance data, and communicate the results.
- Must be proficient in Microsoft Office Suite and practice management/electronic health records systems, preferably eClinical Works.
- Ability to communicate effectively orally and in writing and work well with all levels of staff.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Providers oversight and supervision to all revenue cycle managers including, but not limited to, call center, eligibility, front desk, insurance verification and billing.
- Supports the full revenue cycle through data collection, reporting, analytics and KPI monitoring.
- Manages department budgets and regular reporting requirements.
- Coordinates with clinical operations to reduce preventable operational errors, minimize payment denial, and improve patient care and experience.
- Safeguards the security of cash payments and collection of patient accounts; monitors the accounts sent for collection and reimbursement from Federal, State, insurance company, or other third-party payers; reviews, evaluates and verifies the accuracy of payments and enrollment in programs for compliance; investigates and resolves discrepancies.
- Approves and signs off on all department related expenses, refunds to patients and reimbursement of overpaid fees to insurance carriers.
- Maintains compliance and prevents Fraud & Abuse issues related to billing and collecting patient revenues. Keeps staff current on compliance and Fraud & Abuse issues.
- Manages merchant services vendor contracts for patient payment and collection activities.
- Manages clearinghouse vendor relationship and maximizes services available through that vendor.
- Works with the Accounting Department to maximize utilization of Texas Health and Human Services contract funding.
- Conduct annual review and update of fee schedule (charge master) and sliding fee discount schedules.
- Conduct semi-annual review of all insurance contracts and evaluate opportunities for new contracts.
- Coordinate ongoing provider documentation and coding training.
- Promote SBCHC pharmacy services to all patients.
- Identify opportunities to increase revenue from current services.
- Research and identify new revenue sources, such as billing fee-for-service outside of FQHC reimbursement.
- Develop and implement procedures for billing and collection from new service lines, such as optometry, case management and nutrition services.
- Develop and monitor revenue cycle KPIs.
- Participates in organizational strategic planning activities to ensure the delivery of comprehensive and coordinated health services; serves on committees and task forces to address specific issues and represent the department as assigned; attends meetings and conferences as assigned.
- Develops, maintains and enforces departmental policies, procedures, and work practices to ensure maximum accuracy of patient demographic, financial and insurance data.
- Assures maximization of collections, accuracy of account numbers, billing system integrity, signature authority, codes and insurance status within the framework of what is legal and in compliance with rules, regulations and laws.
- Works with Accounting Department to ensure accurate and timely recording of patient revenue and collections.
- Formulates systematic retention, protection, transfer, and disposal of billing records.
- Coordinates with the IT department and software vendors to monitor and ensure the integrity of the data within the practice management system. Manages the Practice Management side of the Billing system.
- Works on process improvement of Billing functions-using resource sharing and input from sister network FQHCs.
- Leads the implementation of automation and use of artificial intelligence (AI) to facility maximum reimbursements and collections.
- Leads special projects, as assigned.
- Conducts performance reviews as required for assigned staff.
- Performs other duties as assigned by the CFO and/or CEO.
- All Health Center staff members have emergency and disaster response responsibilities. Participates in all safety programs, which may include assignment to an emergency response team.
Insurance & Protection
- Health insurance
- Dental insurance
- Vision insurance
- Life insurance
- Short-term disability insurance
- Long-term disability insurance
- Critical Illness
- Hospital Indemnity