General Summary of Duties: The Revenue Cycle Director directs and oversees the overall policies, objectives, and initiatives of the organization’s revenue cycle activities to achieve operational goals and cash flow targets. Reviews, designs, and implements processes to optimize the revenue cycle and ensure compliance in medical billing, charge capturing, and claims processing for a multi-specialty organization (Oncology, Pulmonology, Urology, Rheumatology, and Diagnostics).
Essential Functions:
Capture, post, and bill all charges within 48 hours from the date of service. Confirm dosages are converted accurately to the billable units.
Ensure coding including diagnosis and CPT codes are accurate at the time of billing.
Verify and reconcile all charges daily against schedules.
Research and resolve any missing charges or data with physicians and departmental office managers.
Ensure all charges are entered and processed, whether electronic or paper.
Submit claims electronically to insurance payers.
Posts monies and works exception codes on the ERAs and paper remits, creating education pointers for the providers.
Follows up on A/R, denials, and incorrectly paid claims, utilizing reports on daily, weekly and monthly basis.
Reconcile A/R daily.
Performs daily audits to ensure that all superbills are entered compared to schedule.
Perform periodic chart and charge audits to ensure the physician’s documentation is complete.
Works with office managers to resolve any issues needed to be addressed at practice level.
Stays abreast on coding and keeps abreast of Medicare and health plan coverage rules.
Perform other necessary duties assigned by the CEO.
Requirements:
- 5-7 years’ experience leading individuals and teams in RCM related departments
- Excellent proficiency with electronic medical records (EMR) and practice management software (NextGen, IKnowmed, Onco EMR and GE CENTRICITY) preferred
- 5+ years Revenue Cycle experience; billing and coding experience a plus
- Oncology experience preferred
