The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or protected veteran status. This company is a VEVRAA Federal Contractor.

Position Goal:The general purpose of the Executive Director Revenue Cycle Management is to develop and direct the revenue management strategies, tools, and interfaces and to oversee the implementation of these strategies.  This position will proactively identify, develop, and execute critical process improvement initiatives to drive best practice performance and favorably impact accounts receivable, cash acceleration, and net revenue.

Position Responsibilities:

• Participate in the strategy and development of the Revenue Cycle centralization for THC, HSC, and JHMH.
• Drives and enables hybrid reimbursement models, along with process redesign to support new clinical models along with technology integration across all domains.
• Provides necessary governance with optimal integration and operational control of disparate Revenue Cycle functions and systems in an effort to optimize revenue cycle management performance.
• Develop, redesign, and monitor new KPIs for presentation and review by Executive Management including payer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other requested parameters.
• Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.
• Serves as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS.  Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems then recommending/implanting solutions.
• Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks
• Ensure effective management of denials by Director of Reimbursement and Manager of HSC and JHMH
• Ensure effective management and appeals of underpayments from insurance carriers
• Ensure contracts are up to date and loaded in the contract manager tool for monitoring
• Oversee staff to ensure timelines are met in regard to the effectiveness, correction of, and policing of late charges
• Ensure review of late charges by department occurs and education occurs on trends and effects of these late charges.
• Ensure DNFB remains within established goals.
• Ensure goals and objectives including productivity goals are established and monitored for each analyst.
• Ensure a process is established for reviewing and approving refunds.
• Maximize workflow efficiencies along with directors and managers of registration to ensure demographic and insurance data are entered accurately and efficiently.
• Propose and analyze (including ROI) new technology and processes to maximize efficiency and accuracy in the revenue cycle process.
• Assist in establishing annual budgets, and ensure the departments are operating within these budgets.
• Ensure staff is educated on new technology, goals, and contracts
• Establish a regularly scheduled revenue cycle meeting to discuss strategies and ensure everyone is educated on the direction of the department.
• Work with Managed Care director in identifying any payer relation issues or contracts that need to be renegotiated or negotiated for the first time.
• Ensure reporting occurs for bi-monthly analysis of physician revenue for every Clinic physician
• Any and all other projects, goals, issues surrounding the revenue cycle, conflicts or concerns as directed or indicated by Executive Management.

Experience: Minimum of 8 years in healthcare revenue cycle management with at least 3 – 5 years in senior management role managing staff of professionals in the revenue cycle environment required.
Education: Bachelor’s Degree, preferably in Business Administration, Health Administration, Accounting, and/or HIS. (Master’s degree a plus)
Special Qualifications: Proficiency with spreadsheet and word processing software; experience with Experian, Medhost, Amkai, and/or Athena a plus; working knowledge of healthcare revenue cycle principles and functions; excellent analytical skills; excellent verbal and written communication skills, ability to lead and manage a group of employees.