Director Revenue Cycle

Position Summary: Responsible for leading and supervising the daily operations and administration of Revenue Cycle functions, including Coding, Billing, Accounts Receivables, and Payment Processing, in three GRHC campuses and multiple IT platforms. Develops department budgets and policies in alignment with organizational vision, mission, and goals. Ensures accuracy, timeliness, and compliance of reimbursement activities by identifying trends in payer reimbursement and monitoring changes in regulations and policies. Leads revenue cycle assessment, analysis, planning, and improvement activities to address organizational and customer needs in an appropriate and efficient manner.

Critical Tasks:

• Plans, develops, and manages department budgets that align with departmental and organizational objectives.
• Prepares monthly revenue and budget projections and presents data to Executive leadership; identifies trends and escalates issues as they arise
• Assists the Chief Financial Officer and Assistant Chief Financial Officer in determining assumptions for budgeting and forecasting revenue during the budget cycle process
• Maintains effective partnerships with other leaders, departments, and remote satellite locations of the hospital to improve operations and management of billing, coding, patient registration, compliance, and system integration.
• Ensures Revenue Cycle department is represented at meetings with Arizona Department of Health Services specifically related to Arizona Health Care Cost Containment System (AHCCCS) billing and with Centers for Medicare & Medicaid Services for Medicare billing
• Monitors quality, effectiveness, and compliance of activities in billing and coding areas by establishing and tracking operational and financial outcome measures and recommending solutions.
• Monitors aging reports, claims denials, and coding efficiency of billing and collecting activities to ensure adherence to quality and quantity standards.
• Develops and establishes policies and procedures to ensure compliance with all federal, state, and licensing regulations, requirements, and practices.
• Coordinates with payers to ensure compliance with contract regulations and identify, discuss, and resolve reimbursement issues. Conducts researches, provides documentation, and reviews recommendations for write-off or adjustments to facilitate payment of billed charges.
• Prepares and distributes regular status and statistical analysis reports about department performance and trends in payer reimbursement. Develops and participates in various process improvement initiatives to maximize efficiency in reimbursement and collections.
• Ensures hospital's Charge Master is updated timely and accurately to ensure service fees and reimbursement rates are in compliance.
• Supervises subordinate staff by providing timely feedback and coaching, mentoring, and training opportunities. Performs other Human Resources administration.
• Manages and adjusts staff schedules by utilizing established volume and workflow indicators.
• Responds to escalated client issues that may impact department success and implements methods to enhance customer satisfaction.
• Oversees the acquisition and maintenance of equipment, stock items, and supplies to meet production priorities of the organization.
• Supports internal or external audit processes as required.

• Performs other job-related activities as requested.

Required Qualifications:

• Bachelor's degree in Business Administration, Healthcare Administration, Accounting, or related field of study required.
• 5 years of experience in hospital-based or physician practice third-party billing and collections required; 8 years preferred.
• Healthcare Financial Management Association (HFMA) certification preferred.
• Proficiency in MS Office Suite and electronic health record (EHR) systems, (i.e., EPIC, NextGen).
• Exceptional communication, interpersonal, and customer service skills.
• Demonstrates ability to relate to diverse cultures and specifically the Gila River Community and/or other Native American cultures and community health services.