Director of Revenue Cycle

TSAOG Orthopaedics is a large multi-specialty physician group. We have been here since 1947 and were not going anywhere.

We take a big part in community outreach with our Light Charity program.

If you are looking for a team that enjoys Laughing, is Family orientated, and has the work hard play hard mentality, then this company is for you.

We value Respect, Communication, Accountability, Dependability and Compassion.

A place where you can rely on great Teamwork and Integrity.

We are a place that is true to its values. If this is what you are looking for then look no further.

Right now we are looking for a Director of Revenue Cycle. The right candidate will be responsible for the development and/or oversight of all systems, departments, policies, staff, training, and strategies related to Healthcare Reimbursement for all billable services performed by the Group to include professional office, anesthesia and ambulatory surgical center services At the direction of the Management Committee and CEO, manage the Groups relationships with Payors/Vendors, whether contracted or not, and establish, maintain, and monitor those relationships in accordance with the contract or strategic plan of the Group and the Texas Department of Insurance (TDI). Focus is on increasing patient populations and decreasing risk of lost revenue through market trends.

What You’ll Do:

Manage, direct and oversee the following areas: authorizations, referrals, financial counseling, professional and facility reimbursement, collections, workers compensation and credentialing
Provide ongoing training and education of physicians, their staff, and all departments in billing regulations, laws, policies, and changes by payors.
Establish and communicate impactful team goals; build and enact plans to achieve success
Accomplish objectives through collaboration with Executive team. Maximize revenue through adherence to strong contracts, complete and accurate coding, and strong collection processes.
Serve as a Direct report for subordinate directors and managers
Stays abreast of new payor or regulatory agency requirements
Serve as a mentor and leader in the capture, management, and collection of patient service revenue, utilizing the drivers of financial performance to attain short and long-term business, service and quality objectives.
Monitor practice management system to ensure claims are sent out regularly and timely
Create rules in practice management system to allow claims to be held when not billed accordingly (i.e., injection not billed with drug, casting not billed with material)
Communicate with EMR provider, regarding needed corrections or intervention
Assess and maintain fee schedule updates, and changes, and address fees charged by Group at least once per year
Communicate positive or negative forecasts with physicians and/or CEO/Management Committee
Maintain current knowledge of federal, state and other governing agencies in regard to collection deadlines and penalties
Establish affidavits of medical necessity for physicians to sign and notarize as appeal process, create and upkeep of appeal letters, bad faith letters, and resources for staff that include current TDI laws and other influences such as tort law or contract parameters. Present and report to physicians or departments this data and adjust as necessary or requested.
Represent the Group in all relationships with Payors – TPAs, IPOs, Work Comp networks, adjustors, case managers, claims auditing firms, Claims re-pricing companies
Perform contract analysis of proposed and existing contracts; Red-line and negotiate all contract language and rates proposed by Payors
Contract and re-negotiate contracts based on the strategic plan and rates decided by the Group. Address breaches in contracts
Maintain cooperative relationships with all Payors, to include inviting one Payor a month (or quarter) as needed to visit Group, in-service staff and answer questions
Review and address any notifications from insurances regarding utilization, physician peer review data, rate changes, network deficiencies, payment methods, and address as directed by Group goals
Oversight of credentialing of all applicable parties, based on contract or need, to hospitals, Payors, PHOs and other entities.
Resource for coding questions for physicians and all service departments
Create policies, procedures and standards that support Best Practices and effective management within a cross-departmental organizational structure.
Reporting:

Productivity reports by provider: claims productivity, referral analysis, and verification.
Trending each month – collection rates, variances not consistent with a drop in productivity for physicians and ancillaries, etc.
Forecasting collection variances based on production for all entities
Create and manage reports to track Payor mix, A/R, collection rates, adjustment rates, bad debt write off, estimated collections and other requested parameters at any given time
Track and analyze appeal rates and success of appeals, appeal letters, forms, formats, supporting documentation, and effectiveness of approach with Payors.
Monitor and trend claim acceptance or rejection rate of physicians and departments; modify where negative.
Monitor late payments by Payor and assess interest, as allowed by contract or law
Other

Any and all other projects, goals, issues or scenarios surrounding: billing, collections, authorizations, Payors, physicians, ancillaries, outside relationships, conflicts, or concerns as directed or asked, or as indicated.

What You’ll Need:

EDUCATION: Bachelor degree in health care administration, business administration, or related field is required.

EXPERIENCE: 5+ years of experience in medical billing and collections required, to include experience in managing multiple employees.

SKILLS: Planning, organizing, problem-solving, multi-tasking, and decision-making skills.

ABILITIES: Analyze and interpret complex data, research, and compare data, and communicate effectively; develop and maintain effective professional relationships.

PHYSICAL DEMANDS/WORKING CONDITIONS: Requires prolonged sitting, stretching, and some bending. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopies, telephone and other equipment. Requires normal range of hearing and eyesight to record, prepare, and communicate appropriate information to patients and team members. Normal, but fast-paced work environment.