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Director of Professional Billing - Revenue Cycle

University of Mississippi Medical Center

Job Description

The Director of Professional Revenue Cycle is responsible for overall management oversight, direction and planning for the effective functioning of all daily operations of professional revenue cycle comprised of, claims submission, claims follow up, provider enrollment, and analytics. These functions include, but are not limited to: working claim edits, properly billing claims, proper identification and follow up on payment denials, enrolling providers with payers, and providing revenue cycle analytics for clinical departments. The Director also acts as a liaison between clinical and operational leadership in order to meet the organization’s strategic goals, missions, and customer requirements.



Jn of The Director of Professional Revenue Cycle is responsible for overall management oversight, direction and planning for the effective functioning of all daily operations of professional revenue cycle comprised of, claims submission, claims follow up, provider enrollment, and analytics. These functions include, but are not limited to: working claim edits, properly billing claims, proper identification and follow up on payment denials, enrolling providers with payers, and providing revenue cycle analytics for clinical departments. The Director also acts as a liaison between clinical and operational leadership in order to meet the organization’s strategic goals, missions, and customer requirements.


Bachelor’s degree in Finance, Business, Health Care Administration, Health Information, Nursing or other related field and seven (7) years related Revenue Cycle experience or equivalent combination of education/experience.



Five (5) years in a relevant management level position in a complex health system or insurance environment. ​



PREFERRED CERTIFICATIONS, LICENSES OR REGISTRATION:


Certified Revenue Cycle Representative (CRCR) through Healthcare Financial Management Association (HFMA), or Certified Revenue Cycle Specialist (CRCS) through American Association of Healthcare Administration Management (AAHAM).


Certified Revenue Cycle Representative (CRCR) through Healthcare Financial Management Association (HFMA), or Certified Revenue Cycle Specialist (CRCS) through American Association of Healthcare Administration Management (AAHAM).Healthcare Administration Management (AAHAM).ription Summary

Job Requirements

  • Must demonstrate a thorough understanding of the full Revenue Cycle with up-to-date knowledge of the industry.

  • Experience recruiting, retaining, & developing high-performing teams is needed.

  • Knowledge of hospital financial & clinical operations is needed, including billing, reimbursement, and provider enrollment requirements for federal & state programs (Medicare, Medicaid) as well as current insurance industry standards.

  • Must be familiar with claims submission and reimbursement requirements for numerous private and government insurance plan types, including preferred provider organizations, health maintenance organizations, third-party administrators, regional physician office plans, point of service plans, etc.

  • Advanced written & verbal communication skills are needed as well as an ability to lead meetings & presentations to management/senior leadership.

  • The ability to delegate assignments to managers/staff; instruct and monitor progress, & review work product for completeness and accuracy.

  • Excellent customer service skills are required along with the ability to deal with difficult situations with tact & diplomacy.

  • Superior ability to handle multiple priorities while maintaining a ‘team’ environment is critical. A strong focus on customer satisfaction & service orientation is imperative.



RESPONSIBILITIES:


  • Directs and coordinates the daily operations for all professional revenue cycle activities.  Ensures that operations are aligned with the strategic goals and objectives that meet or exceeds peer group benchmarks.

  • Establishes on an annual basis and in conjunction with the Chief Revenue Cycle Officer, realistic goals and budgets for the associated areas of responsibility; ensures adherence to the cost center budgets. Acknowledges and supports the organizations defined goals and approach to patient care; exemplifies superior customer service skills, attends regular training sessions and management classes to improve patient and customer communications.

  • Leads multiple teams and assume ultimate accountability for high-quality deliverables through direct and indirect supervision of all Professional Revenue Cycle personnel. Collaborates with training and performance improvement team to identify and develop

  • Maintains current knowledge of and complies with established policies and procedures including patient confidentiality/patient rights, government, and insurance and third-party payor regulations.  Interprets and applies government and managed care billing requirements, and provider enrollment processes.   

  • Develops and is accountable to department performance metrics and produces measurement reports and tools. 

  • Prepares, secures approval of, and oversees implementation of policies and procedures to meet agreed upon performance standards. Enforces organizational policies and procedures to ensure quality customer service, high staff productivity, appropriate cost controls and effective operations.

  • Responsible for working across the organization, creating revenue cycle systems and workflows that will streamline activities among both the hospital and the physician staff. Evaluating and re-engineering processes to optimize revenue cycle performance.

  • Acts as a liaison with other organizational stakeholders designing and implementing effective Professional Revenue Cycle systems and workflows to streamline activities among internal stakeholders.  Evaluates and re-engineers processes to optimize revenue cycle performance.

  • The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all inclusive. Management retains the right to add or change duties at any time.

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Job Snapshot

Location US-MS-Clinton
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type Health Care
Other Compensation: 0

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Terms & Conditions
Snapshot
University of Mississippi Medical Center
Company:
US-MS-Clinton
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care
Store Type:

Job Description

The Director of Professional Revenue Cycle is responsible for overall management oversight, direction and planning for the effective functioning of all daily operations of professional revenue cycle comprised of, claims submission, claims follow up, provider enrollment, and analytics. These functions include, but are not limited to: working claim edits, properly billing claims, proper identification and follow up on payment denials, enrolling providers with payers, and providing revenue cycle analytics for clinical departments. The Director also acts as a liaison between clinical and operational leadership in order to meet the organization’s strategic goals, missions, and customer requirements.



Jn of The Director of Professional Revenue Cycle is responsible for overall management oversight, direction and planning for the effective functioning of all daily operations of professional revenue cycle comprised of, claims submission, claims follow up, provider enrollment, and analytics. These functions include, but are not limited to: working claim edits, properly billing claims, proper identification and follow up on payment denials, enrolling providers with payers, and providing revenue cycle analytics for clinical departments. The Director also acts as a liaison between clinical and operational leadership in order to meet the organization’s strategic goals, missions, and customer requirements.


Bachelor’s degree in Finance, Business, Health Care Administration, Health Information, Nursing or other related field and seven (7) years related Revenue Cycle experience or equivalent combination of education/experience.



Five (5) years in a relevant management level position in a complex health system or insurance environment. ​



PREFERRED CERTIFICATIONS, LICENSES OR REGISTRATION:


Certified Revenue Cycle Representative (CRCR) through Healthcare Financial Management Association (HFMA), or Certified Revenue Cycle Specialist (CRCS) through American Association of Healthcare Administration Management (AAHAM).


Certified Revenue Cycle Representative (CRCR) through Healthcare Financial Management Association (HFMA), or Certified Revenue Cycle Specialist (CRCS) through American Association of Healthcare Administration Management (AAHAM).Healthcare Administration Management (AAHAM).ription Summary

Job Requirements

  • Must demonstrate a thorough understanding of the full Revenue Cycle with up-to-date knowledge of the industry.

  • Experience recruiting, retaining, & developing high-performing teams is needed.

  • Knowledge of hospital financial & clinical operations is needed, including billing, reimbursement, and provider enrollment requirements for federal & state programs (Medicare, Medicaid) as well as current insurance industry standards.

  • Must be familiar with claims submission and reimbursement requirements for numerous private and government insurance plan types, including preferred provider organizations, health maintenance organizations, third-party administrators, regional physician office plans, point of service plans, etc.

  • Advanced written & verbal communication skills are needed as well as an ability to lead meetings & presentations to management/senior leadership.

  • The ability to delegate assignments to managers/staff; instruct and monitor progress, & review work product for completeness and accuracy.

  • Excellent customer service skills are required along with the ability to deal with difficult situations with tact & diplomacy.

  • Superior ability to handle multiple priorities while maintaining a ‘team’ environment is critical. A strong focus on customer satisfaction & service orientation is imperative.



RESPONSIBILITIES:


  • Directs and coordinates the daily operations for all professional revenue cycle activities.  Ensures that operations are aligned with the strategic goals and objectives that meet or exceeds peer group benchmarks.

  • Establishes on an annual basis and in conjunction with the Chief Revenue Cycle Officer, realistic goals and budgets for the associated areas of responsibility; ensures adherence to the cost center budgets. Acknowledges and supports the organizations defined goals and approach to patient care; exemplifies superior customer service skills, attends regular training sessions and management classes to improve patient and customer communications.

  • Leads multiple teams and assume ultimate accountability for high-quality deliverables through direct and indirect supervision of all Professional Revenue Cycle personnel. Collaborates with training and performance improvement team to identify and develop

  • Maintains current knowledge of and complies with established policies and procedures including patient confidentiality/patient rights, government, and insurance and third-party payor regulations.  Interprets and applies government and managed care billing requirements, and provider enrollment processes.   

  • Develops and is accountable to department performance metrics and produces measurement reports and tools. 

  • Prepares, secures approval of, and oversees implementation of policies and procedures to meet agreed upon performance standards. Enforces organizational policies and procedures to ensure quality customer service, high staff productivity, appropriate cost controls and effective operations.

  • Responsible for working across the organization, creating revenue cycle systems and workflows that will streamline activities among both the hospital and the physician staff. Evaluating and re-engineering processes to optimize revenue cycle performance.

  • Acts as a liaison with other organizational stakeholders designing and implementing effective Professional Revenue Cycle systems and workflows to streamline activities among internal stakeholders.  Evaluates and re-engineers processes to optimize revenue cycle performance.

  • The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all inclusive. Management retains the right to add or change duties at any time.

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