Directly responsible for Patient Financial Services, Patient Access, Revenue Integrity, and Health Information Management for both the Hospital and Physician practices to establish best practice functions within these departments; will also manage and direct daily activities and productivity of the leadership of these areas. Responsible for maximizing the collections of medical services rendered from all responsible parties, including but not limited to reimbursement from patients, insurance carriers, and third party guarantors. Responsible for insurance eligibility processes, charge processing, claim submission and processing, payment and collection processes as well as receivable management, denial management, insurance contract review and customer service issues relative to the revenue cycle process. This position is responsible for training and development relative to the revenue cycle, analytics, and all other revenue cycle management activities.
Master’s Degree preferred. Bachelor Degree required in business, healthcare, accounting, or minimum of 10 years Director level experience in Business Office management in a healthcare setting required. CMPA or CPAM certification is a plus. Individual must have strong knowledge of medical insurance billing, patient access, and collections with CPT, ICD-10, HCPCS coding and medical terminology, as well as an overall understanding of managed care products (HMO, PPO). Has current knowledge of regulatory and industry issues effecting medical billing including but not limited to Medicare, Medicaid, ACA. Also knowledgeable of FDCPA requirements regarding charity, collection efforts and filing claims as well as patient rights. Candidate must be able to demonstrate a proven track record of leadership, high performance management, problem solving, business development, employee management, engagement and education.