Director of Revenue Cycle, Planned Parenthood Health Systems, Raleigh, NC

Director of Revenue Cycle

Posted on: May 24, 2013
Application deadline: June 30, 2013
Posted by: Planned Parenthood Health Systems

JOB SUMMARY

Under the general direction of the CFO, drives PPHS revenue cycle optimization as it relates to cash flow and revenue. Ensures compliance with regulations relating to Federal, State, HIPAA and private payer contracts. Plans and oversees the billing revenue cycle operations for a four state operation.

DUTIES AND RESPONSIBILITIES

1. Oversees all aspects of the Revenue Cycle: fee schedule development, chargemaster maintenance, review of billed claims, training of staff on billing functions and revenue optimization.
2. Responsible for all aspects of billing staff supervision. Implements metrics to monitor staff performance, so they can provide clear guidance to staff.
3. Ensure Practice Management System is optimally functioning including charge mapping to NextGen EMR system to ensure that claims process through correctly to the EPM. Assists with EMR as needed.
4. Maintain Third Party Insurance contracts with Commercial and Medicaid Payers and Pharmacy Benefit Managers. Obtain new contracts with insurance carriers and seeks to expand access to patients when advantageous to PPHS. Assist VP of Finance with contract renegotiation as needed. Also work with network providers to resolve payment issues.
5. Focal point for any new revenue generating programs to ensure appropriate set-up and integration into the revenue cycle. Ensure new programs are communicated effectively to all staff involved and that systems are in place to track and collect these revenues. Provide ad hoc reporting on these programs to help track their progress and minimize potential risk areas.
6. Identifies missed revenue opportunities. Analyzes the actual volume of visits versus budget and prior year. Reports on reasons for budget variances and suggests focus areas for the Health Centers to improve on visits and revenues.
7. Maintain Fee Schedule. Propose at least annually the change in fees for the organization. Disseminate and train staff on fee schedule. Update fee schedule as need for new codes and obsolete codes.
8. Review revenue posted to the Accounting System to ensure that revenues are stated appropriately. Manage all revenues and related general ledger receivable accounts.
9. Direct the billing functions: billing, cash posting, follow-up and refunds to ensure that the functions are effective and efficient. Supervises the Billing Manager.
10. Prepare monthly dashboard reporting to help Management review the current state of Accounts Receivable. Provide other reporting as requested.
11. Ensure that insurance verification is being performed optimally to ensure proper billing and collections.
12. Meet metrics established for billing department including, but not limited to: denials, aging, claim submission, etc.
13. Provide training and consultative assistance to Health Centers on coding, billing, credits, collections and revenue issues. Ensure site visits are made to provide assistance, but also ensure compliance. This includes training for orientation of new staff.
14. Maintains the Billing and Compliance Manual including at least annual updates.
15. Oversees provider credentialing.
16. Other duties as assigned by the Vice-President of Finance.

QUALIFICATIONS NEEDED

Education: Must possess a minimum of a Bachelor's Degree in a business or administrative healthcare related field. MBA preferred.

• Certified Coder designation strongly desired. Advanced working knowledge of CPT-4, ICD 9, 10 coding requirements and OIG billing compliance guidelines.
• Experience: Minimum of [5] years experience in revenue cycle operations with at least [3] years experience in a relevant revenue cycle leadership role and (3) years of supervisory experience.
• Experience with Electronic Medical Record (EMR) and Electronic Practice Management (EPM) systems is required, NextGen experience preferred.
• Minimum 3 years experience managing or directing patient registration, time of service collections and charge entry functions in a specialty setting.
• Ability to demonstrate extensive knowledge of third-party and insurance company operating
  procedures, regulations and billing requirements, and government reimbursement programs. They have a thorough understanding of medical information systems for billing and accounts receivable, spreadsheet analysis, reporting applications, medical terminology, and coding and office procedures.
• Possess successful record of adding value to organizations through the proactive analysis and resolution of potential bottlenecks that may negatively affect the organization's reimbursement and accounts receivable. Must demonstrate a record of significantly improving patient accounts receivable and delivering additional revenues.
• Must possess superior communication skills, demonstrate the ability to work in a team environment, and be able to effectively direct front and back-end work processes and personnel toward a common goal.

Personal: Commitment to and understanding of PPHS goals and mission. Must be flexible and able to work independently. Must have strong organization skills. Some travel necessary.
Vision: Required to read and analyze data daily.
Hearing and Speaking: Required to hear telephone and communicate with staff, patients and public daily via telephone and in person.
Agility and Dexterity: Required to perform written communication daily. Required to use office equipment necessary to the performance of job duties (telephone, computer, printer, copy machine, fax).
Mental: Ability to read and comprehend data daily.

HOW TO APPLY

Visit www.pphs.org to apply.