Director of Revenue Cycle Management

DescriptionAbout Primary Health SolutionsOur MissionWe meet people where they are and partner with them on their journey towards wellness.Our VisionThe destination for servant leaders to provide comprehensive and exceptional care.Our ValuesR RespectI InnovationS StewardshipE Excellence Director of Revenue Cycle Management I SummaryThe Director of Revenue Cycle Management I oversees all Revenue Cycle functions and will contribute to the day-to-day operations on all issues related to the revenue cycle, provide analysis, create written processes, and train others to establish a cross-functional Revenue Cycle team. This is a remote leadership position requiring the ability to effectively manage and develop a geographically dispersed (remote) revenue cycle team.A Day in the LifeOversee the following revenue cycle functions including coding, charge capture, billing, payer enrollment, claims processing, payment posting, accounts receivable, and denial management.Monitor key performance indicators (KPIs) such as days in A/R, clean claim rate, denial rate, and net collection rate; implement corrective actions as needed.Oversee denial management strategies and appeals processes to ensure timely resolution.Analyze denial trends and implement process improvements to prevent recurrence.Ensure timely payer enrollment for all providers and collaborate with HR and operations to ensure providers are billing-ready by date of service.Ensure timely and accurate submission of claims in compliance with FQHC billing requirements leveraging multiple technical programs inside and outside of NextGenReview financial hardship applications (sliding fee scale). Ensure timely and professional resolution of patient billing inquiries and complaints.Collaborate with Patient Access Department to support the front desk with insurance billing and sliding fee knowledgeCollaborate with Clinical Operations and Practice Optimization teams to ensure EHR/clinical workflows are compliant with FQHC billing and all revenue opportunities are billedCollaborate with Quality Department to optimize quality program reimbursementSupervise internal and external Revenue Cycle personnel in various duties, such as A/R management, issue resolution with insurance plans, collections, cash posting, contract analysis, and billing. Lead, coach, and develop a remote revenue cycle team across multiple functional areas.Oversee hiring, onboarding, training, and performance management.Works directly with payers and reviews payer contracts. Always negotiate for PPS methodology reimbursement with payer contracts. Manage vendor relationships for RCM partners such as clearinghouse and external coders. Attend internal NextGen committee meetings and contribute to cross-departmental projectsOversight/management of NextGen billing tables in file maintenance in partnership with NextGen hostPerforms all other duties and tasks as assigned. Core CompetenciesCustomer Service: Committed to increasing customer satisfaction, sets proper customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met.Communication: Understand and communicate effectively with others using a variety of contexts and formats, which include writing, speaking, reading, listening and interpersonal skills.Dependability: Meets commitments, works independently, accepts accountability, handles change, sets personal standards, stays focused under pressure, meets attendance/punctuality requirements.Quality: Is attentive to detail and accuracy, is committed to excellence, looks for improvements continuously, monitors quality levels, finds root cause of quality problems, owns/acts on quality problems.Productivity: Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, and handles information flow.RequirementsSuccess RequirementsTo 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 accommodation may be made to enable individuals with disabilities to perform the essential functions.Education/ExperienceBachelors degree in healthcare administration, business, finance, or related field preferredMinimum of 710 years of progressive revenue cycle experience, preferably within an FQHC or community health setting.Experience with payer enrollment, billing compliance, coding, and payer relations. .