The Revenue Cycle Director directs the performance, in conjunction and counsel of the Revenue Cycle leadership, of the acute revenue cycle activities of outsourced vendors and in-house functional areas of Patient Access (including but not limited to Patient Scheduling, Pre-Access/Registration, Registration Admissions, and Financial Counseling), Health Information Management (including but not limited to Site Medical Records management, Release of Information, Transcription), and Patient Financial Services (including but not limited to Billing, Charge Master/Revenue Integrity, Insurance Follow-Up, Customer Service, Cash Posting, Denials Management, Payment Variance, and Collections).
Leadership: Has a continuous and consistent presence in both the assigned facilities and Revenue Cycle Services Center (RCSC) to provide support, review processes, provide feedback and identify areas of opportunity. Travel requirements will be: 10 business days per month in assigned facilities, 5 business days per month in the RCSC and the remaining business days to be determined by business needs. Maintains knowledge of Revenue Cycle best practices ensuring high productivity and proficiency standards are met. Promotes a culture of collaboration between the RCSC and facilities and serves as a positive role model for Revenue Cycle. Demonstrated ability to manage the day to day operations of multiple mid to large sized organizations providing a diverse and complex offering of services to the community. Ensures that appropriate documentation and education materials are used in all local Patient Access areas and identifies any educational needs and communicates to the appropriate leader for development. Understands and stays abreast of payer requirements and changes in the industry and communicates those changes as well as the financial impact to local leadership. Represents Revenue Cycle on site-specific Finance and Operations meetings.
Performance Monitoring/Improvement: Works collaboratively with the RCSC to understand impact of facility operations and workflows on Revenue Cycle performance. Has a working knowledge of RCSC projects and performance metrics, how they relate to best practice and industry standard benchmarks and the operational changes necessary to ensure top tier performance. Monitors performance KPIs and routine reports including, but not limited to: Registration Accuracy, POS Collections, Denial Rate, Estimate Utilization, Elective Self-Pay, Timely Recurring Discharges, DNFB/CFB, High-Dollar InHouse, Medical Necessity Issues, Recoupments, Charge Reconciliation and Accuracy, and Late Charges. Review and resolve accounts on hold or in DNFB/CFB status and work with appropriate leadership for Missing Documentation or Claim Edits. Serves as Chair of Denial Avoidance Committee and ensures performance improvement plans are developed and implemented.
Communication: Hosts routine calls with facility and RCSC leadership and ensures open communication to discuss KPIs, denial trending, front end issues, missing documentation issues. Provides a monthly CFO KPI packet to include, but not limited to: Cash collections and variance to goal with detail explanation, A/R greater than 150 days with root causes, Denials trending by payor and root cause, Recoupments by payor and root cause, DNFB/CFB with any root causes. Provides updates to facility leadership on ongoing RCSC projects and their impact on performance metrics. Provides timely information to RCSC on operational changes, new business development, and service line expansion that will impact Revenue Cycle. Communicates in a way that promotes trust and credibility between the RCSC and facility leadership and strives to strengthen local and corporate relationships for positive outcomes. Completes weekly/monthly market narrative of activities, projects in flight, and issues. Escalates issues to direct leader as necessary to ensure timely resolution.
Qualifications - Minimum
Bachelors Degree strongly preferred, Masters Degree a plus
Excellent working knowledge of the hospital revenue cycle
5-7 years of experience in healthcare and hospital revenue cycle
Must pass the Certified Revenue Cycle Representative Examination offered through Healthcare Financial Management Association within 90 days of hire, unless already certified. Must complete all system-specific education and certifications (Epic) as determined by leadership.
Ability to travel 50% of the time to regions (Youngstown and Toledo, OH)
Full-time, 40 hours per week, 8:00 a.m. to 5:00 p.m.
Equal Employment Opportunity
It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.
This position will be a part of the revenue cycle team at Ensemble Health Partners - a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.