The Revenue Cycle Operations Consultant will work to assist in coordinating the overall functions of Clinic’s Business Office to ensure maximization of cash flow while improving patient, physician and other customer relations. This includes management oversight of all business related functions of the patient visit from point of entry to accurate adjudication of patient’s accounts. Primary responsibilities include leadership and development of management staff, analysis of staffing and general expenses to meet budget for the department, process execution to meet cash/collection targets, guidance of managers and staff to exceed customer service targets, and enhancing communication with Providers relative to revenue cycle issues. Additionally the Consultant may provide assistance to the Vice President of Business Services by overseeing special projects. Overall areas of responsibility are Registration, Billing and Collections, Patient Insurance, Data Processing, Integrity of Patient Accounts, and Accounts Receivable Management.
The Revenue Cycle Operations Consultant will report to the Director of Revenue Cycle and may report to any of the following and others as assigned: Managers of Revenue Cycle, PSR Business Unit Managers, and Supervisors Business Office.
The Consultant will be supervised by the Executive Vice President Revenue Cycle of Southwind.
Plans and directs registration, patient insurance, billing and collections and data processing to ensure accurate patient billing and efficient account collection.
Manages Patient Accounts within the established budgetary guidelines, develops ongoing monitors of performance, and provides a “dashboard of key indicators” to the Clinic’s management team.
Evaluate the current status of patient accounts to identify and resolve billing and processing problems in a timely manner.
Establishes and implements a system for the collection of delinquent accounts ensuring third-party payors are contacted.
Develops and recommends credit and collection policies for front and back end personnel to administer. Monitors and makes recommendations for improvement.
Solves difficult payment and associated business office problems. Audits problem accounts.
Coordinates exchange of information with Medical Records and other departments to obtain and analyze additional patient information to document and process billing, respond to insurance inquiries, and manage liability accounts.
Manages Billing Systems training personnel assigned to front-end and business office operations.
Manages the work process within Patient Registration and Business Services. Develops work standards, monitors quality and quantity of work processed, and ensures that policies are communicated and administered consistently.
Works with Business Services Systems Coordinator to ensure timely and accurate administration of work processes within the system including the submission of electronic claims to third party carriers, claims logic development and maintenance, custom reporting and electronic remittance of third party payments.
Coordinates with the Vice President of Business Services, an annual capital equipment budget for Business Office operations.
Oversees the management of all personnel within assigned Business Office areas. Trains, orients and evaluates performance of assigned personnel, recommends merit increases, promotions, and disciplinary actions.
Monitors daily operating activity of the Business Office and makes necessary adjustments in work assignments to maintain optimal accounts receivable and customer relations.
Maintains current knowledge of, and complies with established policies and procedures including patient confidentiality/patient rights, government, insurance and third party payor regulations.
Participates in professional development activities and maintains professional affiliations with area of expertise.
Clarifies, communicates and consistently applies all Clinic policies and disciplinary standards.
Maintains effective communication with all other departments.
Encourages the development and productivity of staff through coaching and counseling.
Delegates responsibilities in a prudent manner.
Must read and understand the Clinic Compliance Policy and Procedure Handbook.
Must inform members of management and/or compliance officer if addressed with an issue that challenges compliance policies.
Performs other related duties incidental to the work described herein.
Minimum of 5 years professional experience in project Management or experience in a medical office setting
Ability to effectively establish cooperative relationships with patients, physicians, staff and other customers
Proven knowledge of ICD9, CPT, and HCPCS
Proven knowledge of payer requirements, including Medicare and Medicaid
Proven analytical skills
Experience with PC and office software
Coding Certification (CPC or equivalent)
Ability to communicate effectively in person and in writing
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