Director of Revenue Cycle

Department:Business Office

Reports to:Chief Financial Officer (CFO)

FLSA Status:Exempt

Type of Position:Full-Time

Revised Date:04/05/2024

MISSION & VISION STATEMENT:

The Kewa Pueblo Health Corporation (KPHC) is established for the purposes of carrying out the vision and mission of the Santo Domingo Health Center (SDHC). The MISSION of KPHC is: “ENSURING HEALTH & WELLNESS THROUGH EXCELLENCE IN HEALTHCARE WITH RESPECT FOR CULTURE” and the VISION OF KPHC is:  “HEALTHY PEOPLE, HEALTHY COMMUNITY, and HEALTHY LIFESTYLE”.

POSITION PURPOSE:

The Director of Revenue Cycle is responsible for the direction and leadership of operational, financial, programmatic and personnel activities for Revenue Cycle, including provider enrollment, claims, payments, credit balance, insurance reimbursement, and self-pay management. The director works closely with a variety of stakeholders, coordinating the activities of the Revenue Cycle across the corporation.

PERFORMANCE EXPECTATIONS:

In the performance of their respective tasks and duties all employees of the Kewa Pueblo Health Center are expected to conform to the following:

• Uphold all principles of confidentiality and patient care to the fullest extent.
• Adhere to all professional and ethical behavior standards of the healthcare industry.
• Interact in an honest, trustworthy, and dependable manner with patients, employees, and vendors.
• Possess cultural awareness and sensitivity.
• Maintain a current insurable driver’s license.
• Comply with all Kewa Pueblo Health Corporation and Santo Domingo Health Center policies and procedures, as well.

ESSENTIAL DUTIES, FUNCTIONS & RESPONSIBILITIES:

• Oversee and support the daily operations of the revenue cycle & credentialing team including billing, follow-up and collections, cash posting, metrics reporting and project to improve efficiency with the billing department.
• Establish and maintain departmental policies and procedures. Communicate relevant information to other departments. Establish controls and review mechanisms to ensure procedures are being followed correctly.
• Prepares and delivers reports to operational leadership outlining progress toward meeting annual goals and objectives, including performance related to finance, clinical activity, quality, and safety.
•  Remains current with new trends and best practices and incorporates them into Revenue Cycle practices and programs.
• Designs and executes training programs for personnel to effectively perform revenue cycle responsibilities, with a specific focus on medical coding.
• Develops and implements clinical outcome measures for quality improvement, cost, and complication reduction, and the implementation of evidence-based medicine.
• Creates business plan(s), justifying variances and analyzing cost benefit of programs.
• Directs and guides managers to effectively allocate resources based on patient volume, space, availability, budget constraints, and program priorities, goals, and objectives.
• Maintain records related to operations and services that are complete, accurate, available, and in compliance with all legal, regulatory, and policy requirements.
• Complete third-party audits relative to claims, collection agency activities, and identification of issues.
• Identify and correct operating issues that will maximize the effect on cash flow.
• Participate in negotiations with both current and targeted insurers.

MINIMUM MANDATORY QUALIFICATIONS:

Education:

• Bachelor's degree in business or related field.

Experience:

• Minimum eight (8) years of progressive responsible management experience in a healthcare business setting and at least five (5) years in a related leadership role.
• Experience with medical third-party billing and payment and regulation management.

Mandatory Knowledge, Skills, Abilities, and Other Qualifications:

• Excellent communication and interpersonal skills including the ability to negotiate and resolve conflicts and build teams.
• Knowledge of general accounting principles.
• Knowledge of medical terminology.
• Knowledge of healthcare billing codes (CPT, ICD-10, HCPCS).
• Knowledge and understanding of state and federal rules and regulations.
• Ability to operate in high-pressure situations.
• Excellent organizational skills, planning, and project management abilities.
• Demonstrated innovative approach to problem resolution.
• Broad knowledge of modern health care administration practices and principles.
• Effective analytical ability to develop and analyze options, recommend solutions to and solve complex problems and issues.

PREFERRED QUALIFICATIONS:

•          Master’s degree in business, healthcare administration, or related field.

• Certified Medical Coder

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the primary functions of this job. Normal office conditions exist, and the noise level in the work environment can vary from low to moderate. Travel during the daytime, as well as limited overnight travel may be required from time to time. This position may expose the incumbent to certain health risks that are inherent when working within a health center facility. The Public Health Nursing Department holds events outside throughout the year.  Cold weather, wind, dust, and/ or heat are common during these events. 

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk and hear. There may be prolonged periods of sitting, keyboarding, and reading. The employee must occasionally lift and/or move up to 50 pounds.

MENTAL DEMANDS:

There are several deadlines associated with this position. The employee must also multi-task and interact with a wider variety of people on various and, at times, complicated issues. The ability to communicate effectively, meet deadlines, and multi-task is essential to this position.

OTHER:

All employees must fully uphold all principles of confidentiality and patient care. This position has access to sensitive information and a breach of these principles will be grounds for immediate termination.

Disclaimer:  The information on this position description has been designed to indicate the general nature and level of work performance by employees in this position.  It is not designed to contain, or be interpreted as, a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position. Employees will be asked to perform other duties as needed.

Salary Range:  $119,059.20 to $178,588.80