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Director, RCM Full-time Regular Pittsburgh, PA, US
17 days ago Requisition ID: 1073
The Director of RCM has direct oversight of the internal and
external billing and collection operations. The incumbent is
expected to work closely with the Manager of RCM, RCM Analyst, and
Credentialing team to ensure accurate, compliant and timely billing
in an effort to maximize cash collections through optimization of
RCM processes, renegotiation of payor contracts and participation
in payor incentive programs. It is also the responsibility of the
incumbent to align and optimize RCM through proactively managing
and setting process improvement initiatives with our third party
billing provider. The incumbent is expected to act independently
and exercise judgment regularly consulting the CFO when
ESSENTIAL FUNCTIONS AND ACCOUNTABILITIES:
Work with the billing contractor to ensure the timely, complete
and accurate transfer of billing data from treatment sites to the
Proactively manages and fosters a working relationship with our
billing contractor to ensure RCM is being optimized and continues a
process of improvement.
Establish and monitor reconciliation processes to ensure that
all eligible services are captured and billed.
Conduct or oversee routine coding audits to ensure accurate and
compliant diagnosis and procedure codes utilization.
Establish and monitor audit processes to ensure that billed
procedures are being paid in accordance with governmental and
negotiated contract allowances.
Establish with the CFO billing Key Performance Indicators,
monitor actual performance to established benchmarks, report
progress to management, and work with the billing contractor to
achieve desired outcomes.
Provide the CFO and management the standard and ad hoc reports
required to manage the organization successfully.
As a member of the management team, communicate and coordinate
effectively with the various managers in support of organization’s
goals and objectives.
Troubleshoot and work with the billing contractor to resolve
Foster a customer-centered organizational culture through
professional and efficient service to practice management and staff
and the billing contractor.
Ensure compliance with rules and regulations surrounding the
documentation and billing of professional services
Provide supervision to the Manager, RCM & RCM Analyst.
Promotes positive employee relations and works effectively with
HR to ensure a harassment free environment.
In performance of all duties, acts in accordance with the
company’s mission, vision and values
Adheres to the company’s code of conduct.
Handle other duties and special projects as assigned.
MINIMUM QUALIFICATIONS REQUIRED:
Education: Bachelor’s degree in accounting, healthcare or
business administration is required. Master’s degree in related
field is preferred. Combination of education and experience is
acceptable and will be considered.
Experience: Minimum of five (5) years of relevant work
experience in the field of health care revenue cycle; includes
patient financial services, patient access or other revenue cycle
work. Progressive managerial experience highly desired.
Knowledge, Skills & Abilities:
Ability to direct, control, and supervise the revenue cycle
Proficient with computer systems capabilities and procedures
Excellent interpersonal skills are required to train and
Must possess analytical and problem-solving skills and ability
to effectively communicate and work with both public and staff
Ability to analyze information and prioritize various tasks in a
fast paced environment
Advanced working knowledge of Medicare, Medicaid and third-party
Strong values, ethics and integrity, proven decision making
Possess well developed skills in effectively interacting with
physicians, executives, peers and cross-functional teams.
TYPICAL PHYSICAL DEMANDS/WORKING CONDITIONS: Refer to Working
Conditions and Physical Demands for Office Personnel with