Job Description

Role & responsibilities Develops and implements strategies to enhance revenue integrity and ensure compliance with healthcare regulations and standards Oversees the billing & collections functions which include: billing, accounts receivables, managed care contracting and vendor management of all secondary functions (early out, collection agency, global resources, coverage discovery, etc.) Monitors provider enrollment activities and denials for impacts on account receivable. Works with credentialing to identify opportunities for improvement Identifies opportunities for process improvement within revenue cycle to increase efficiency, reduce errors, and enhance patient satisfaction Monitors and analyzes key performance indicators (KPIs) for revenue cycle to identify trends, variances, and areas of opportunities to enhance financial integrity Leads initiatives to reduce denials, optimize reimbursement, and manage payer contracts effectively Serves as subject matter expert related to revenue integrity matters, providing education and support to Revenue Cycle Management (RCM) staff on best practices in billing and collections Collaborates with IT and clinical informatics teams to leverage technology for improved revenue cycle data analytics Collaborates with department leaders from Coding, Compliance, and Clinical Operations to identify and address revenue cycle improvement opportunities for strategic development Continuously maintain knowledge on best practices to identify areas for improvement to streamline revenue cycle processes with payors Prepares reports and presentations for senior leadership, outlining revenue integrity performance and recommendations for improvement Develops and implements standard operating procedures that impact RCM and Managed Care processes and procedures Evaluates payor reimbursement patterns to identify opportunities for managed care contracting Ensure department compliance with all relevant regulations, including HIPAA, CMS guidelines, and payer requirements Performs other related duties as assigned Preferred candidate profile Strong understanding of healthcare billing, collections, compliance, and regulations Strond understanding of Revenue cycle platforms and soft ware like - Waystar, Ezclaim e.t.c . Proven track record of improving revenue cycle metrics and financial performance Excellent leadership and team management skills Strong analytical, problem-solving, and decision-making capabilities Effective communication skills, both verbal and written Collaborate with professionals internal and external to the company and across geographic locations Exhibit growth mindset and team-orientated behaviors Navigate competing priorities and effectively work in a fast-paced environment Education: Bachelor's degree in Finance, Healthcare Administration, or related field; MBA or relevant graduate degree preferred Experience Minimum of 7 years of experience in revenue cycle management, with at least 3 years in a leadership role 4+ years of healthcare industry experience strongly preferred Professional fee billing experience preferred Emergency Medicine and/or Hospital Medication experience preferred