Director of Revenue Cycle

Director of Revenue Cycle

Our Culture- Why work with us:

Joining Outer Cape Health Services isn't just about taking on a new role; it's about embracing a mission that goes beyond the day-to-day. Here, you become part of a dedicated team committed to safeguarding and nurturing invaluable community health resources. Our ethos is built on creating a vibrant and inclusive workplace where every team member is valued and recognized for their unique contributions.

Who We Are:

Our mission is to provide a full range of primary health care and supportive social services that promote the health and well-being of all who live in or visit the ten outermost towns of Cape Cod.

OCHS now cares for more than 20,000 patients annually, and no one is denied access to services due to an inability to pay. Founded in 1987 through the merger of Health Associates of Provincetown (established in 1972) and the AIM Medical Center in Wellfleet (established in 1966), Outer Cape Health has a long history of successful growth and expansion in pursuit of this mission. As a Patient-Centered Medical Home, OCHS holds itself to the highest standards. Ensuring patients have access to care when they need it and request it and validating that staff are working at the top of their licensures are the foundations of this model.

Our Core Competencies:

At Outer Cape Health Services, our core competencies are the foundation upon which our organization is built, guiding us in our mission to deliver exceptional health services to our communities. Our focus on fostering teamwork ensures that we operate as a cohesive unit, valuing each member's contribution and working synergistically towards common goals. Integrity and honesty stand at the heart of everything we do, creating a culture of trust and respect among our team and the communities we serve. Embracing technology, we continually seek innovative solutions to enhance our services and operations. Finally, being patient-centered, we prioritize the needs and well-being of those we serve, striving to exceed expectations and make a meaningful difference in their lives.

A Day in the Life of this Role:

Reporting to the Senior Director of Operations, the Revenue Cycle Director oversees and manages the full revenue cycle, ensuring maximum revenue capture and compliance with all regulations and insurance policies. The Director's efforts impact the entire process-from provider enrollment and credentialing, as well as initial patient registration, to final payment collection-and the incumbent will work with the appropriate key stakeholders, including, but not limited to, operations, clinical, finance, billing, and electronic medical record (EMR) staff to ensure that data collection, billing, coding, insurance claim, and customer service processes are aligned, compliant, and known by staff.

Summary of Duties:

• Works closely with the Senior Director of Operations and other members of the Executive Team to support strategic planning, transparent communication, and staff training related to the revenue cycle and collections.
• Is the main point of contact and vendor relationship manager for OCHS' contracted billing company, which performs pre-registration, billing and credentialing services.
• Serves as the liaison between the outside vendor and the key leaders and stakeholders within OCHS who oversee or participate in portions of the revenue cycle.
• Oversees the Healthy Connections Team, which provides insurance enrollment assistance to patients and community members.
• Ensures proper and up-to-date provider credentialing and rostering with payers including commercial insurance, Medicaid and Medicare. Communicate timely with clinical and operational leaders on the status of new providers and any changes of status for existing providers.
• Works closely with clinical leadership to ensure providers are properly documenting and billing all services rendered. Collaborates on required training/education for providers and serves as internal contact for questions related to billing and clinical documentation.
• Works closely with operational leadership to ensure the front-end staff have the required standard operating procedures, scripts and forms to effectively verify, capture and communicate all required information and referrals/authorizations ahead of a visit. Collaborates on required training/education for front line staff and serves as internal contact for questions related to the front-end portion of the revenue cycle.
• Works closely with the finance leadership to research and support financial issues such as unapplied payments and patient refund requests.
• Serves as the main point of contact within OCHS for any patient questions or complaints related to charges or a bill. Requires close coordination with the Billing Call Center, which is operated by the third-party billing company.
• In collaboration with the contracted billing company and OCHS' internal EMR Team, maintains the charge master, reviewing and updating as needed.
• Reviews all reports and invoices coming from the contracted billing company to ensure all work is being performed in a timely, accurate and compliant manner. As needed, prepares reports and/or executive summaries to OCHS leadership on key revenue cycle metrics.
• Assesses current processes and policies that impact revenue cycle, identifying problems or roadblocks that exist and proposing potential solutions.
• Stays informed on any regulatory, legal and billing/coding changes that go into effect that would impact revenue cycle activities and/or workflows. Proactively communicates new information to leadership.
• Attends webinars, trainings and workgroups related to billing and revenue cycle activities.
• Other related duties and projects as assigned.

What we need from you:

• At least 5 years of experience as a Revenue Cycle Manager or in a similar position.
• Bachelor's degree in healthcare administration, business or finance preferred.
• At least 2 years of experience as a supervisor or manager. Experience managing remote staff preferred.
• Strong familiarity with medical coding and healthcare billing required; being a certified coder is a plus.
• Experience working with a federally qualified health center (FQHC) or other primary or ambulatory care organization a plus.
• Knowledge of HIPAA regulations.
• Experience with the Epic EMR a plus.
• Strong written and verbal communication skills. Experience communicating with diverse stakeholders (i.e. medical providers; front desk staff; patients; insurance providers; c-suite leaders, etc.).
• Experience managing a vendor's performance and serving as a liaison between internal stakeholders and an external vendor.
• Experience interacting with patients and families, particularly related to researching and resolving questions or issues related to patient charges and bills.
• Strong analytical and problem-solving skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy.
• Ability to work within a collaborative team setting and independently.
• Proficiency in computer skills including Epic, Outlook, Microsoft Office, OneDrive, etc.
• Excellent judgment and ability to solve problems in a timely manner.
• Ability to adhere to strict confidentiality standards.
• Demonstrated ability to work in a culturally diverse and inclusive environment.

AAP/EEOC Statement
Outer Cape Health Services is committed to providing equal employment opportunity in all our employment programs and decisions. Discrimination in employment on the basis of any protected class under federal, state, or local law is a violation of our policy and is against the law. Equal employment opportunity is provided to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, covered veterans' status, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, political affiliation, or any other protected characteristic. This policy applies to all terms and conditions of employment, including, but not limited to, recruitment and hiring, placement, promotion, termination, reductions-in-force, recall, transfer, leave of absence, compensation, and training.

In accordance with Massachusetts law, we are committed to wage transparency. The salary range for this position is $100k-$135. This range is provided to promote equity and transparency in our hiring process. Actual compensation may vary based on factors such as experience, qualifications, internal equity, and other job-related criteria.