The Director Revenue Cycle is responsible for managing all activities related to maximizing revenue for the Department of Surgery. S/he must have an in-depth knowledge and understanding of the business operations and decision support systems in a multi-specialty physician practice. They should have a proven ability to lead a team and take responsibility for the overall performance of the Revenue Cycle, including accounts receivable, billing, and coding.
Monitor monthly volume, billing, and accounts receivable reporting and evaluate exceptions to goals to ensure maximum performance, and initiate timely corrective actions, if necessary; Analyze trends and summarize for leadership review and decision making. Translate data into meaningful, actionable information and provide insight into strategic implications; Coordinate and develop monthly performance results compared to plan for each area; identify and direct activities that will result in revenue optimization and expense implications; Accountable for revenue cycle performance from point of patient contact into the practice through adjudication of the bill; Oversee Department billing and coding staff; Serve as primary liaison with PBO and billing and coding vendors; Manage vendor activities, holding them accountable for timely follow up, appropriate claim follow up and timely/accurate coding; Monitor that all revenue cycle policies and procedures are followed and report/address exceptions; Work with physicians and practice staff to ensure compliance with all revenue-related issues; serve as liaison with hospital Compliance Department; Work with both internal and external auditors to meet regulatory requirements; Oversee the management of the credentialing activities to optimize turnaround time from initiation to carrier acceptance at the provider level; Knowledge and understanding of patient billing and accounting system reports and performance measurement tools. Ability to compare department and subspecialty performance to internal goals/industry benchmarks and take corrective action to improve results; Report actual provider results against contract requirements and make recommendation for corrective actions to achieve desired results; Review and monitor all payer contract and reimbursement requirements to ensure each payer is meeting contract provisions; and Report monthly payer mix and reimbursement results compared to contract and industry benchmarks and develop actions to improve revenue cycle performance.
Boston Medical Center