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Director of Revenue Cycle & Patient Access, Chicago, IL


PrimeCare Community Health

Director

Chicago, IL

November 29, 2018


Director of Revenue Cycle & Patient Access

Position Summary: This position assumes responsibility for oversight of the full revenue cycle from scheduling to registration to enrollment to billing.

Duties and Responsibilities

  • Responsible for maximizing the collection of medical, dental, and behavioral health services payments and reimbursements from patients, insurance carriers, financial assistance, and guarantors.
  • Responsible for evaluating, reviewing, and implementing all policies and procedures related to insurance eligibility processes, charge processing, claim submission and processing, payment processing, collections and accounts receivable management, denial management, reporting of results and analysis, concurrent and retrospective auditing, proper coding, credentialing, insurance contract review and oversight, patient services, training and development as it pertains to the full revenue cycle, analytics, and all other revenue cycle management activities.
  • Hire, train, supervise, and evaluate:
    • Directly the Manager of Revenue Cycle and the Manager of Access & Enrollment and
    • Indirectly A/R Specialists, Patient Enrollment & Access Specialists, Registration, and Centralized Scheduling.
  • Develop and maintain policies and procedures for efficient and accurate processing of encounters in the Registration area.
  • Oversight of all business-related functions of the patient visit from point of entry to accurate adjudication of the patients’ account.
  • Develop and make recommendations on information analyzing claims, utilization, and medical cost data and prepare monthly statistics.
  • Ensure standard processes are being followed throughout all steps of the revenue cycle process.
  • Monitor aged accounts, determine appropriate procedures, and verify appropriate collection procedures are being followed. Regularly provide CFO with revenue cycle status including reports and metrics.
  • Oversee the maintenance of enrollment rosters and empanelment services.
  • Manage revenue cycle projects at the organizational level, such as audits and budgets.
  • Develop, monitor, and address business metrics in order to refine processes and improve efficiencies by establishing internal goals and identifying external benchmarks.
  • Identify goals and vision for the full revenue cycle team, such as guiding individuals and teams toward priorities, clarifying roles and responsibilities, coordinating resources, and arranging organizational systems to meet objectives that align with the company’s vision and business goal.
  • Oversight of the enrollment and credentialing of all providers (physicians, physician assistants, nurse practitioners, mental health providers, dentists, hygienists, etc.) and clinics with all insurance companies, Medicaid, and Medicare.
  • Assist in preparing UDS reports.
  • Update PrimeCare’s Fee schedule on an annual basis.
  • Determine and provide training for all providers on proper billing techniques.

Minimum Qualifications

  • Bachelors’ degree in Finance, Business, or equivalent OR 8 years of revenue cycle management experience required.
  • 3 years of overall management experience required.

Preferred Qualifications

  • Master’s degree in Finance or Business Administration.
  • Prior experience with FQHCs.
  • Knowledge of third-party payer rules and regulations, as well as health center billing operations.
  • Ability to present information in an easily understandable manner.
  • Certified Coding Specialist Certification.
  • Proficient in Spanish or Polish.

Knowledge/Skills/Abilities and Other Characteristics

  • Individual must have strong knowledge of medical, behavioral health, and dental insurance billing and collections with CPT, ICD-10 and HCPC coding and medical terminology, as well as an overall understanding of managed care products (HMO, PPO, etc).
  • Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint), with strong written and verbal communication skills.
  • Demonstrated ability to work effectively with a diverse set of employees and with multiple disciplines in both clinic and administrative settings and often in a team-based environment.
  • Must have strong leadership, analytical, and problem-solving skills.
  • Must conduct yourself with integrity and treat others fairly.
  • Demonstrated ability to analyze health care operations and make creative improvements.
  • Ability to communicate in a confidential and HIPAA-compliant manner.
  • Ability to demonstrate respect and sensitivity for cultural diversity, gender differences, and sexual orientation of patients and coworkers and maintain appropriate professional boundaries with all staff, trainees, and patients at all times.

Send resume to Javier Alaniz at javier.alaniz@primecarechi.org


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