Director of Revenue Operations

DEPARTMENT

Management

LOCATION

Somerville, Mass.

EDUCATION

Bachelor's Degree

EXPERIENCE

see job description

JOB DESCRIPTION

The Director of Revenue Operations is a critical role that is responsible for overseeing the full revenue cycle and billing office operations. The successful candidate is tasked with maximizing the collection of medical services payments and reimbursements from patients, insurance carriers, financial aid, and guarantors. Areas of ownership include but are not limited to collections and accounts receivable management, denial management, reporting of results and analysis, concurrent and retrospective auditing, insurance contract oversight, customer services relative to revenue cycle, training and development relative to revenue cycle, analytics, and all other revenue cycle management activities.

A key member of the management team, the Director of Revenue Operations is responsible for general oversight and management of the Billing Office. Directly managing a group of Team Leads, the Director monitors productivity and performance of all Business Office personnel, manages escalated employee relations issues, and works in conjunction with Human Resources to identify areas for policy and procedural improvement for the Business Office.

RESPONSIBILITIES

  •  Management oversight of all business-related functions of the patient encounter from point of contact to accurate adjudication of the patients’ accounts;
  • Ensures that the Cataldo Ambulance Service, Inc. Corporate Compliance and Integrity Program is adhered to at all times;
  • Makes suggestions for updates in accordance with shifting policy and compliance changes;
  • Keeps up to date on the compliance landscape for EMS (Emergency Medical Services) industry;
  • Specific areas of responsibility include revenue cycle training, claims management, collections, patient insurance, data processing, compliance, accounts receivable management, and third-party revenue cycle vendors (collection agencies);
  • Responsible for provider reimbursement programs, policies, and strategies to ensure unit cost controls meet or exceed corporate objectives for medical cost containment;
  • Analyzes claims, utilization, and medical cost data;
  • Develops strategic, cost effective programs, and makes system or network changes to enhance competitive position;
  • Monitors aged accounts and verifies appropriate collections procedures are being followed;
  • Manages revenue cycle projects, such as audits and budgets;
  • Serves as primary point of contact for third-party collection agencies;
  • Takes the lead on all external audit requests;
  • Serves on Compliance Committee & Security Committee;
  • Regularly provides upper management with revenue cycle status including reports, metrics, and presentations;
  • Develops, monitors, and assesses business metrics in order to refine processes and improve efficiencies;
  • Establishes internal goals and identifies external benchmarks;
  • Compiles and prepares periodic KPI reports for Senior Management;
  • Resolves escalated reimbursement issues with Payors and systems for optimal management of accounts receivable;
  • Develops, implements, and maintains the company’s revenue cycle standard operating procedures (SOPs);
  • May develop training materials and facilitate staff training of SOPs, systems, metrics, government regulations, etc.;
  • Remains current on all regulatory changes and updates company policies accordingly;
  • Management and oversight of the Business office;
  • Directly manages a group of Team Leads, and works with them to set priorities and delegate work throughout the rest of the staff;
  • Develops and implements progressive short-term goals that align with the company’s vision and business goals;
  • Cascades goals down to staff’s annual objectives;
  • Responsible for all employee life cycle activities of Business Office staff;
  • Accurately assesses strengths and development needs of employees;
  • Gives timely, specific feedback and helpful coaching;
  • Provides challenging assignments and opportunities for development;
  • Responsible for interviewing, recommending hires, assessing performance, recommend salary changes, and progressive discipline;
  • Enforces adherence to Cataldo Ambulance Service’s policies;
  • Performs other duties as assigned.

 

MINIMUM QUALIFICATIONS

  •  
  • At least 4 years of medical revenue cycle management experience required with a consistent track record of achieving metrics and at least 2 years supervisory experience successfully resolving a variety of people issues;
  •  Overall revenue cycle experience should exceed 9 years;
  •  Proficiency in all federal and state regulations related to billing of ambulance and wheelchair van services;
  •  Individual must have strong knowledge of medical insurance billing and collections with CPT, IDC9, and HCPC coding and medical terminology, as well as an overall understanding of managed care products (HMO, PPO, etc.);
  •  Proficiency in Microsoft Office.

 

 

The above are intended to describe the general nature and level of the work being performed by the person/people in this position. This is not an exhaustive list of all duties, responsibilities, knowledge, skills, and abilities associated with this position. Cataldo Ambulance is an Equal Opportunity / Affirmative Action Employer All qualified applicants will receive consideration for employment without regard to disability, race, color, veteran status, religion, sex, or national origin. Individuals with Disabilities and Veterans are encouraged to apply.

 

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