Senior Director of Billing and Revenue Cycle Management
Summary:
The Senior Director of Billing and Revenue Cycle Management will drive and manage the overall Insurance and Managed Care billing and managed care services for this global healthcare provider. This includes strategic contracting and provider credentialing, claim billing, patient account verification, claims management, insurance and managed care accounts receivable and third-party collections. This role is an integral member of the leadership team, and partners closely with Sales Management, Finance, Operations and Compliance; providing a strong focus on compliance, accuracy and integrity of billing and collections procedures. Core competencies of a successful team member will include subject matter expertise of Insurance, a familiarity with Six Sigma or Lean Operations concepts, and a good working understanding of how Insurance Operations processes .
Responsibilities:
- Oversee and manage multiple specialty teams, including: billing, contracting and credentialing, benefit verification, claims and collections.
- Define, implement, and manage clear quality and productivity standards for all department individuals across all areas of responsibility.
- Routinely conduct audits and analysis to ensure optimal claims processing and reimbursement.
- Stay abreast of third-party payer and governmental regulations and requirements as well as company policies and procedures to ensure billing compliance and timeliness of collections. Proactively implement operational changes and provide timely staff education to maintain adherence.
- Proactively identify areas for improvement and engage with IT support to make necessary changes in the system.
- Coordinate with the legal and compliance departments to address payer issues; and to ensure that the organization is compliant with federal and state regulations.
- Monitor and report on key metrics, including but not limited to cash collections, net A/R days, aging, initial denial rates, underpayments, clean claims %, write-offs, payment-to-charge percentage. Proactively perform root cause analysis and develop action plans when metrics do not meet internal goals or industry best practices.
- Inform senior leadership about trends and issues impacting performance. Summarize detailed data in a clear and concise manner so that information is actionable and in an easy-to-understand format.
Qualifications:
- Four year college degree from an accredited institution. Finance, Accounting or Business degree, MBA preferred
- Minimum seven years billing and receivables management experience
- Medical device industry experience a plus
- Proven remote location support in a professional, retail, consumer goods or healthcare clinic setting; preferably for a rapidly-growing multi-state, multi-location, customer-focused business
- Strong understanding of revenue cycle processes and technology
- Knowledge of third party (government and non-government) billing regulations and various payer methodologies
- Ability to research and interpret regulatory guidance and third party payer contracts