Director, Revenue Integrity
Description
JOB SUMMARY
The Director of Revenue Integrity manages functions of the organizations billing and revenue cycle to maximize cash flow while maintaining and improving internal and external customer relations.
Manages revenue cycle activities, overseeing all payment posting and accounts receivable activities. The role will manage the analytics on denial management, identifying and resolving friction within the billing system. Responsible for the coordination of these efforts together with site personnel to ensure accuracy and timeliness. The Director works to implement leading practices and operations that will positively impact the Revenue Cycle and help the Central Business Office operate according to industry benchmarks. In addition, the Director will work to ensure GoHealth’s Revenue Cycle policies and procedures are followed in the multiple markets.
JOB REQUIREMENTS
Education
- High School Diploma or GED required
- Bachelor’s degree in Science, Business, or a related field or in lieu of degree, six (6) years of relevant work experience will be accepted in addition to the experience requirement required
- Master’s degree in related field preferred
Work Experience
- Five (5) years of experience exhibiting advanced performance in a physician billing revenue cycle or Central Business Office required
- Three (3) years of leadership/management experience required
Required Licenses/Certifications
Additional Knowledge, Skills and Abilities Required
- Advanced knowledge of third-party insurance, and familiarity with insurance plan types; HMO, PPO, POS, and Indemnity.
- Thorough knowledge of Medicare Fraud and Abuse regulations as well as HIPAA regulations.
- Possesses advanced knowledge of Practice Management Systems with expertise in billing.
- Detailed and process improvement oriented.
- Strong knowledge of the Accounts Receivable process
- Ability to work both independently and as a member of a team to solve complex revenue cycle issues.
- Ability to apply complex analysis and interpretation in order to assess issues involved in the financial and technical aspects of medical practice revenue management, including coding, billing, reimbursement and collections metrics, policies and procedures.
- Facilitates project management, on-going support, follow-up analysis and implementation support for projects with widely varying scope.
- Presents and communicates in a professional and effective manner.
- Clear and effective written and verbal communication skills.
- Skill and ability to handle multiple priorities and deadlines.
- Strong aptitude for adaptability and flexibility in dynamic environments.
- Strong demonstration of applied project management rigor.
- Demonstrated proficiency in the use of business support software applications such as MS Office (Word, PowerPoint, Excel, Visio, etc.).
- Prepares periodic and/or as requested status reports that quantitatively and qualitatively inform of project progress and results.
- Ability to analyze data and present findings to reporting director.
- Ability to develop and manage projects and workflow reengineering.
- Excellent phone, communication, organizational skills, computer skills and mathematical skills]
- Ability to maintain patient confidentiality
- Strong problem-solving skills and ability to make timely decisions
Additional Knowledge, Skills, and Abilities Preferred
- Epic or eClinicalWorks experience
- Experience with Microsoft Excel and Word
Core Competencies:
- Collaboration: Takes ownership for collectively establishing productive partnerships and relationships and seek to gain joint understanding of priorities and objectives so that the greater good of the organization and those we serve is always at the forefront.
- Innovation: Consistently uses good judgment, applying creativity to overcome obstacles and increasing effectiveness and efficiency though process and other forms of innovation.
- Diversity and Inclusion: Fosters diversity and inclusion, to be able to better understand team members, our customers and partners. Engages the strengths and talents of each GoHealth team member, creating an environment of involvement, respect and connection where the richness of ideas, backgrounds and perspectives are harnessed.
- Integrity: Models and practices the highest ethical and professional standards; demonstrates pride and personal interest in our patients, partners and fellow team members, deeply engaging in the business. Makes decisions, with a focus on doing the right thing; treats team members, our customers, partners and vendors with dignity, consideration, open-mindedness and respect.
- Accountability: Always shows initiative, demonstrates a bias to action and gets things done. Actively accepts responsibility for diverse roles, obligations and actions that positively influence patient and customer outcomes, our partnerships and the healthcare needs of our communities
ESSENTIAL FUNCTIONS
- Maintain Daily communication with direct reports and team leads.
- Maintain a high level customer service approach to working with Accounts Receivable Specialists, external vendors, and payors
- With support of the VP; interview, hire, and review team members
- Implement audits of team’s efficiency and thoroughness when working outstanding AR accounts
- Produce and maintain key performance metrics around Days in AR, cash collections, initial and final denials, etc.
- Oversees the management of select revenue cycle personnel. Trains, orients and evaluates performance of assigned personnel, recommends merit increases & structured bonus calculation, promotions and disciplinary actions.
- Optimize the efficiency and effectiveness of workflow processes and policies for the account receivable department
- Develops work standards, monitors quality and quantity of work processed, and ensures that policies are communicated and administered consistently to meet departmental goals. Works closely with coding and regional operation managers to monitor compliance to policies and procedures as they relate to the revenue cycle.
- Ability to motivate and engage team members
Required knowledge, skills and ability:
Technical service skills:
- Ability to recommend new approaches, policies, and procedures to influence continuous improvements in department’s efficiency and services
- Ability to conduct root cause analyses to identify areas where the process may not be working effectively or efficiently. Working with the Revenue Cycle VP, facilitates and manages process improvement efforts in the entities to drive improvement in the overall revenue cycle process.
- Ability to create and approve training manuals, policies and procedures, and job aids for Revenue Cycle areas.
Customer Service Skills:
- Ability to represent the Department in a professional manner when interacting with patients, guests, physicians and their staff
- Ability to handle service issues professionally
- Ability to follow through with customers
Communication Skills:
- Ability to communicate effectively to patients around the financial aspects of their care.
- Ability to communicate effectively to patients, centers, and staff regarding departmental policy
- Maintains effective, consistent communication with Revenue Cycle team. Identifies and facilitates the resolution of issues that arise and impact markets
Keyboard skills:
- Ability to type proficiently
Teamwork:
- Ability to function effectively as extension of the Center
- Be flexible and open-minded in thought processes
- Maintain focus under pressure
- Share relevant information with other team members
Medical Terminology & Insurance
- Ability to understand basic medical terminology
- Ability to calculate deductible and co-insurance correctly
- AbilIty to read and understand carrier Explanation of Benefits
All other duties as assigned
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Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.