Director of Revenue Cycle-Pro Fee (F/T) Remote

Optim Health System is seeking a full time Director of Revenue Cycle - Pro Fee. This is a remote position, however, must live within a 60 mile radius to Savannah, GA.

General Summary: An exempt, management position responsible for managing all aspects of Revenue Cycle to include; coding, account receivables, reimbursement and collection functions of the company.

Essential Job Responsibilities:

1. Manages the department within the established budget.

2. Manages the coding process implemented to assure the most accurate and cost-effective coding of all claims.

3. Manages the filing and resolution of claims with individual carriers or agencies. Insures maximum reimbursement through strategic financial planning.

4. Monitors changes in the medical insurance industry and adjusts procedures accordingly. Aggressively pursues cost reimbursement through settlement negotiations.

5. Reviews and evaluates health insurance claim policies and procedures for insurance plans, develops new procedures to improve the quality and quantity of work processed.

6. Monitors and evaluates monthly insurance reimbursements compliance and budgets.

7. Manages updating of contract matrix with accurate terms and fee schedules and establishes a common reimbursement grid by procedure code.

8. Manages the collection of accounts, the maintenance of the Medicare bad debt and the outsourcing of account receivables following appropriate protocols.

9. Solves difficult insurance claim problems.

10. Supervises, trains, and mentors assigned personnel. Evaluates performance and recommends merit increases, promotions and disciplinary actions.

11. Initiates and answers pertinent correspondence. Prepares and writes reports. Maintains required records and files.

12. Maintains knowledge of and complies with established policies and procedures.

13. Assists in care and upkeep of department equipment and supplies.

14. Attends required meetings and participates in committees as requested.

15. Participates in professional development activities and maintains professional affiliations.

16. Maintains patient confidentiality.

Education: Bachelor’s degree required

Experience: Minimum five years supervisory experience in a health care setting.

Other Requirements: None

Performance Requirements:

Knowledge:

1. Must have knowledge and ability in medical office procedures.

2. Knowledge of the precertification/authorization process as it relates to physicians, hospital and ASC.

3. Knowledge of medical billing/collection practices as they relate.

4. Knowledge of basic medical coding, CPT, diagnosis and HCPCS codes.

5. Knowledge of insurance payer procedures practices and contracts.

6. Knowledge of governmental legal and regulatory provisions related to billing and collection activities.

7. Knowledge of data analysis, systems design, problem identification, and medical data processing practice.

Skills:

1. Skill in establishing and maintaining effective working relationships with other employees, patients, physicians, insurance organizations and the public.

2. Skill with computer applications and use of calculator.

3. Skill with analytical and statistical reporting.

4. Skills in the use of excel spreadsheets for monitoring of statistics.

Abilities:

1. Ability to deal courteously with patients, physicians, co-workers and others.

2. Ability to communicate clearly and follow written and oral instructions.

3. Ability to resolve conflicts productively.

4. Ability to manage and mentor supervisory staff.

Equipment Operated: Standard office equipment including computers, scanners, fax machines, copiers, printers, telephones, postage machines etc.

Work Environment: Position is in a well-lighted office environment. Occasional evening and weekend work.

Mental/Physical Requirements: Involves sitting approximately 90 percent of the day, walking, bending, stretching, or standing the remainder. May require lifting up to 30 pounds.