Revenue Cycle Director, Santa Barbara, CA
Planned Parenthood California Central Coast is hiring a Revenue Cycle Director!!!
Your passion makes the difference!
As the most trusted provider of reproductive health care, we promote the ability of all individuals to lead fulfilled lives, build healthy families, and make informed decisions through high-quality health services, education, and advocacy.
JOB TITLE: Revenue Cycle Director
DEPARTMENT: Patient Accounting
REPORTS TO: CFO
The Director of Revenue Cycle will maximize opportunities to improve all areas of the revenue cycle operations, ensuring that PPCCC is paid and collecting in compliance with all regulations and contracts. The Director will ensure that the privacy of patient information is secured and meets HIPAA regulations. This position will manage revenue cycle staff and work throughout the organization to maintain optimum cash flow and a minimum number of days in accounts receivable.
- Ability to consistently model Planned Parenthood Workplace Values:
- We tend to the team
- We respect and honor all people
- We jump in
- We try and we learn
- We care for our business
- We return to our mission
- Ability to demonstrate Services Standards in all internal and external communication by:
- Clearing the slate
- Making a connection
- Keep them in the loop
- Confirm the plan
- Ask for feedback
- Acknowledge the reality
- Open the door
- Maintain knowledge and expertise on third party billing requirements. Monitor and keep appropriate personnel informed of changes in regulations for Federal, State, Medi-Cal, and other third party payers. Ensure affiliate compliance with government regulations for patient eligibility and billing.
- Track overall performance of revenue cycle, identify areas of improvement and implements solutions. Regularly review all key components of revenue cycle process through dashboards, reports, queries, and other tools. Monitor timely and accurate billing, coding, collections and follow up through reporting metrics and other analytical tools.
- Ensure accurate and timely preparation and submission of billing information and posting payments received. Monitor unpaid claims and follow-up or re-bill as needed to ensure timely payment.
- Maintain computer data files for the affiliate fee schedule, procedure codes, CPT codes, ICD codes, and related data files. Responsible for ensuring the integrity of charges and SIM library. Coordinate system changes with the iCare team and IT.
- Responsible for and leads reviews and changes of contracted rates, fee schedule, annual updates of sliding scale, poverty guidelines, 340b pricing, RVU’s, and supply charges and reviews with key members of Senior Leaders.
- Coordinate with Medicare, Medi-Cal and private payers regarding contractual arrangements and fee schedules in the counties patient care is provided. Work closely with the CFO in managing these contracts. At least annually, evaluate the terms and financial results of these agreements. Assure that these agreements meet PPFA standards. Coordinate the details of delivery of care, such as authorizations, etc. by the terms of these agreements by collaborating with Clinical Services. Ensure that our profiles are kept current.
- Produce statistical reports required by Federal, State and private funding sources and by PPFA. Respond to inquiries from management for specialized reports on data available through the billing software.
- Assure coding quality and compliance with coding guidelines and reimbursement requirements. Interface with key revenue cycle stakeholders including clinical and operational leadership to identify workflow issues and barriers to an effective revenue cycle process; and recommend and helps implement solutions.
- Work with information technology resources and operational leadership to identify EPM and EHR related workflow issues that impact the effectiveness of revenue cycle processes; identify and help to implement solutions.
- Review and monitor all revenue cycle interfaces to identify workflow issues and barriers to an effective revenue cycle process for provider billing. Recommend and helps implement solutions. Lead and/or participate in other revenue cycle projects as assigned. Review and maintain familiarity with payer contracts for the clinic.
- Coordinate with Finance the flow of billing information to the accounting department in a timely manner to meet financial reporting deadlines.
- Maintain billing files, computerized and paper, and annually purge both onsite and offsite storage as allowed by funding sources and affiliate policy.
- Manages IVS, Claims Management and Patient Accounting. Select, train, supervise, evaluate and dismiss, if necessary, the Patient Accounting Department Staff.
- Serve on affiliate compliance committee, iCare Team and other committees as assigned.
- Attend PPAC Meetings and participate in PPAC calls/webinars, network with other affiliate managers. Visit and provide training to clinical centers from time to time.
- Monitor all activities measured by PPFA accreditation standards. Provide training to staff and to Center Directors regarding the reduction of denials and other standards.
- Maintain a department policy and procedure manual. Review and update it annually, along with the clinical policies and procedures related to patient accounting.
- Communicate with fiscal intermediary concerning rates, rate changes, settlement payments, recoupments, recoveries. Oversee the verification of remittance advices, for the accuracy of each report.
- Follow and stay updated on all compliance issues by CMS and Medicaid that will affect billing regulations. Adhere to all regulatory and HIPAA requirements.
- Work with other departments to analyze and recommend change regarding issues related to non-payment of claims or payer denials identified in the electronic billing system.
- Collaborate with outside vendors on resolving system questions and problems.
- Participate in audits, including preparation and review of requested audit schedules, reports and documentation.
- Attend and participate in Coordinating Team/Large Management meetings, offering suggestions related to operational improvement, scheduling, coding, HIPAA and compliance issues.
- Perform other related duties as assigned by the CFO.
Responsible for the supervision of the following positions:
- Direct supervision of Administrative Insurance Billers, Claim Analysts, Insurance Verification Specialists and Exit Billers.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- In-depth knowledge of governmental and commercial insurance rules and regulations, including Medi-Cal, Medicare and FPACT.
- Solid understanding of CPT-4 and ICD-9/10 codes.
- Must have supervisory experience.
- Working knowledge of both Electronic Health Records and Practice Management processes, preferably in using Nextgen.
- Produce statistical and billing reports on client characteristics, visits, etc.
- Background in use of the following metrics to the dashboard: initial denial rate, recovery rate, charge lag days, unbilled rate, net to gross rate, expected reimbursement vs. actual collections and clean claims rate to the dashboard – this business intelligence data will enhance the leadership’s efforts to better monitor and manage organizational performance.
- Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
- Understanding of the basic principles of statistics and ability to produce statistical reports is required.
- Strong oral and written communication skills required.
- Must be detail oriented, organized, and able to meet deadlines.
- Must have a valid driver’s license as this position requires travel to workshops and other Planned Parenthood sites including but not limited to PPCCC’s geographic area (Thousand Oaks to San Luis Obispo).
- 5+ years of healthcare revenue cycle and supervisory experience.
- Professional Coder Certification preferred.
- Extensive knowledge of the healthcare professional revenue cycle environment and a strong understanding of medical billing principles.
- Must have strong knowledge and experience in AR Management. Experience in revenue cycle system implementation, configuration, assessment and EMR. Knowledge of NextGen and medical records information system.
- Current knowledge of Medicare/ Medi-Cal/ Medicaid billing requirements and guidelines. Proficiency using a PC and various software applications (i.e. Word, Excel, Microsoft and Outlook). Knowledge of medical terminology, CPT (Current Procedural Terminology) and ICD10.
- Ability to establish and maintain effective working relationships with administrators, physicians, and peers. Ability to develop and implement strategies for efficient workflow.
- Ability to develop, analyze, implement, and monitor productivity levels and quality improvement strategies. Work experience in handling cash, checks, and donations.
- Excellent communications skills, verbal and written. Knowledgeable of accounting principles related to revenue cycle and to laws, regulations and guidelines pertaining to health care administration.
- Ability to seek out new methods and principles and be willing to incorporate them into existing business and accounting practices.
- Must possess strong analytical; time management; organizational; problem solving and decision making skills.
CUSTOMER SERVICE RESPONSIBILITIES:
- Interact with staff in a professional and helpful manner and to respond to their requests efficiently and effectively, so as to ease and improve communications regarding finances.
- Develop reports and analysis that can be easily comprehended by non-accounting personnel.
- Excellent customer service skills and commitment to providing the highest level of customer satisfaction.
EDUCATION and/or EXPERIENCE:
- Bachelor's degree in Business Administration, Finance, Accounting, Health Care Administration, or equivalent experience.
- Five years of experience in a healthcare setting is required.
- Ability to read, analyze, and interpret the most complex documents.
- Ability to respond effectively to the most sensitive inquiries or complaints.
- Ability to write speeches and articles using original or innovative techniques or style. Ability to make effective and persuasive speeches and presentations on controversial or complex topics to top management, public groups, and/or board of directors.
- Minimum five (5) years’ experience with computerized management/billing systems.
- Must have strong computer skills, including ability to use spreadsheet and word processing software.
- Excellent computer skills in a Microsoft Windows work environment.
- NextGen experience a plus.
- Ability to work in a busy environment, under pressure without compromising accuracy, attention to detail and courtesy to clients and staff.
- Ability to provide feedback to staff in a constructive manner resulting in motivation for change
- Ability to respond appropriately to changing situations
- Willing to work flexible hours, including Saturdays and evenings when necessary
- Ability to read and analyze information (business and Medi-Cal journals)
- Ability to research and gather information
- Ability to organize large amounts of data/information into a fashion that all levels of staff can understand.
- Candidate must travel within PPCCC geographic area (Thousand Oaks to San Luis Obispo)
- Other duties as assigned
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Ability to interpret a variety of instructions and deal with several abstract and concrete variables.
- Ability to take decisive action.
While performing the duties of this job, the employee is regularly required to stand, walk, and talk or hear. The employee frequently is required to use hands and fingers to handle or feel and reach. The employee is occasionally required to sit. The employee must occasionally lift and/or move up to 25 pounds.
If you would like to be considered for this position, please apply online to: https://jobs.lever.co/ppcentralcoast