POSITION TITLE:                            Director of Revenue Cycle

REPORTS TO:                                Chief Financial Officer

FLSA Status:                                  Exempt

Date:                                               January 2024

 

Organizational Overview:

Manet Community Health Center serves the broad health needs of patients and residents across our service areas by delivering high quality, individualized, culturally sensitive primary care, behavioral health and supportive services for families and individuals of all ages. The health center is a federally qualified community health center (FQHC), fully licensed by the Department of Public Health, accredited by The Joint Commission, recognized by the National Committee for Health Assurance (NCQA) as a Patient-Centered Medical Home, and certified for Diabetes Self-Management Education and Support. A multi-site community-based health center, Manet ensures that our patients have unfettered access to all levels of the health care system and is especially committed to providing services for the medically underserved. Manet has three locations in Quincy, and one each in Hull, Taunton and Attleboro, Massachusetts – with two new sites opening in 2023: a school-based health center in Taunton and a clinic within a Housing Resource Center in Quincy for homeless and housing insecure individuals. Manet is committed to providing community leadership and collaboration to improve health outcomes for the residents and communities we serve.

 

General Definition and Scope of Job

The Director of Revenue Cycle and Billing reports directly to the CFO of the organization.  She/he is responsible for billing staff, individual insurance companies’ accounts receivables, and preparation of monthly reconciliation.

Core Responsibilities

  • Supervises the collection and entry of encounter forms within two working days to complete the month end process;
  • Monitors the billing staff activity of the insurance accounts receivable to decrease first pass denials;
  • Sets up a process that monitors all urgent care charges to be billed to Medicaid;
  • Maintains knowledge of billing regulations, CPT and ICD9 codes, and provides supervision where needed;
  • Maintains fee schedule and appropriate files for remittance advices, patient files, and encounter forms;
  • Posts all obstetrical charges within five days;
  • Closes system within seven working days after month end;
  • Interfaces with consultants, software vendor and CIO
  • Responds to, and provides guidance to, address inquiries and requests from patients and third party payers and resolves/follow-ups with policies;
  • Reviews or supervises review of accounts with staff and reviews write-offs with CFO. Reviews aging on a monthly basis with CFO with the intent of keeping third party receivables over 180 days to a minimum and total days outstanding under 60 days;
  • Provides training of staff in patient accounts systems and software and knowledge of regulations concerning their areas of responsibility. Meets weekly with staff to foster communication on issues, ongoing training, and problem solving;
  • Interfaces with front desk, medical, and management staff on issues related to maximizing revenue and services provided, and to support accurate documentation and data collection reflecting services;
  • Participates in meetings with management, supervisors, and other departments to represent patient account activities;
  • Interviews, selects, makes recommendations and important personnel actions and procedures related to patient accounts staff, and evaluates staff on an annual basis;
  • With the help of the CFO, sets days outstanding and dollars over 180 days goal;
  • Before month closes, writes-off all cap and free care charges;
  • Performs other job-related duties as required or assigned;
  • Serves as a liaison with Manet’s PMS. And maintains denial management and rules building to ensure accounts are processed accurately;
  • Monitors the payment reconciliation process with the accounting department for accuracy and compliance;
  • Sets up the reporting system for data controls to identify and correct operational issues;
  • Maximizes the electronic collection process for patient accounts over 60 days; and,
  • Creates and maintains monthly reports to ensure best practices functionality are being followed.

Minimum Skills, Experience and Educational Requirements:

Education: Possession of a Bachelor degree from an accredited college or university with a major in business administration, finance, accounting, health care administration or a closely related field.

Experience: Three (3) years of full-time or its equivalent experience in an administrative, managerial or supervisory position with direct responsibility for delivery of patient business services, patient accounting services, insurance billing services, collection services or patient financial counseling services in a health care services organization.

Skills, Abilities, Competencies Required:

  1. Patient accounting or business services department in a health care facility;
  2. Data processing and billing systems as they relate to health service financial accounting and billing;
  3. Principles of patient relations and customer service;
  4. Principles and practices of continuous quality improvement;
  5. Federal and State laws, codes, rules and regulations relating to Health Services fiscal and service delivery operations, including registration, service procedures, medical records, confidentiality, protected patient health care information, billing, and revenue collections;
  6. Medicaid and Medicare rules and regulations;
  7. Basic methods and procedures of financial record keeping;
  8. Microsoft Word and Excel;
  9. Standard accounting procedures in relation to billing, collections, and health center revenue cycle;
  10. Federal, State, and private health insurance programs, billing, eligibility standards, and coding;
  11. Emerging trends regarding clinical, educational, and technological developments in the health care industry;
  12. Principles and practices of organization, administration, personnel management, labor relations, cost center management, and budgeting; and,
  13. Principles and practices of conducting and responding to internal and external fiscal audits.

Critical Demands of the Job

  • Manage multiple requests and prioritize appropriately;
  • Ability to function in a fast-paced setting with a variety of patients and staff;
  • Attention to details and prompt follow up;
  • Includes walking and standing for long periods of time, sitting for short periods of time, hand dexterity, clear hearing and speaking ability. Must be able to lift a maximum of 1/3 of their body weight;
  • Excellent organizational and interpersonal skills; and,
  • Must be responsive to multiple deadlines.

Working Conditions

  • Works in well-lighted environment with comfortable surroundings;
  • Stressful at times due to competing demands, including attention to multiple patients and staff; and,
  • Will comply with all applicable laws, and will cooperate with the Manet Community Health Center compliance program rules and regulations.

Required Availability

May be required to work evenings, holidays or weekends, if department requires.