Under the supervision of the VP/Chief Financial Officer, the Revenue Cycle Director is responsible for the strategic oversight and management of the entire revenue cycle process within the hospital, from billing to collections. This role demands an intimate knowledge of payor requirements and contracts, denials and appeals, and key business office KPIs such as clean claim rate, days in AR, Denial Rate, etc. The Director will develop and execute strategies to enhance revenue cycle efficiency, minimize denials, and ensure optimal financial performance.

KEY RESPONSIBILITIES

Revenue Cycle Management:

• Oversee all aspects of the hospital’s revenue cycle, including billing, coding, charge capture, and collections.
• Develop and implement strategies to improve revenue cycle efficiency and effectiveness, ensuring the achievement of key financial goals.
• Monitor and analyze revenue cycle performance metrics, including clean claim rate, days in AR, net collection rate, etc.

Payor Requirements & Compliance:

• Maintain a thorough understanding of payor contracts, regulations, and reimbursement policies.
• Ensure compliance with all federal, state, and local regulations related to billing, coding, and reimbursement.
• Collaborate with payors to resolve issues, negotiate terms, and optimize reimbursement rates.

Denials Management:

• Develop and implement a comprehensive denials management program to reduce denial rates and recover lost revenue.
• Analyze denial trends to identify root causes and implement corrective actions.
• Lead a team responsible for the timely review, correction, and resubmission of denied claims.

Appeals Process:

• Oversee the appeals process, ensuring timely and effective resolution of denied claims.
• Work closely with the clinical and coding teams to gather necessary documentation for successful appeals.
• Track and report on the success rate of appeals, making improvements to the process as needed.

Team Leadership & Development:

• Lead, mentor, and develop a team of revenue cycle professionals, including billing, collections, and denials management staff.
• Promote a culture of collaboration and accountability, focusing on continuous improvement. Work closely with cross-functional partners to achieve shared goals.
• Conduct regular performance reviews, offering continuous feedback, training, and development opportunities to enhance team capabilities

Strategic Planning & Reporting:

• Work with executive leadership to develop and execute revenue cycle strategies that align with the organization's financial goals.
• Prepare and present regular reports on revenue cycle performance, including trends in denials and appeals, to senior management.
• Identify and implement best practices and emerging technologies to enhance revenue cycle efficiency and effectiveness.

MINIMUM EDUCATION:

Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field; Master’s degree preferred.

MINIMUM WORK EXPERIENCE:

Minimum of 7-10 years of experience in healthcare revenue cycle management, with at least 5 years in a leadership role.

REQUIRED LICENSES/CERTIFICATIONS:

None.

REQUIRED SKILLS, KNOWLEDGE, AND ABILITIES:

Knowledge and expertise in hospital managed-care contracting, billing and collection for services provided. Intimate knowledge of payor requirements, including Medicare, Medicaid, and commercial insurance. Proven expertise in denials management and the appeals process. Excellent communication, negotiation, and leadership skills.

ABOUT OAKBEND:

OakBend Medical Center is an independent hospital providing exceptional and compassionate care to patients and the community since 1950. The OakBend family consists of outstanding team members caring for the community at three hospitals and many specialty centers. OakBend’s services and programs include its signature No Wait ER, an advanced trauma center, certified stroke program, hospital air ambulance services and a hospital-based skilled nursing facility. We remain committed to providing a rewarding environment to our team members, to providing necessary services to the community and to developing the best methods to care for our patients, ensuring a healthy future for generations.