SUMMARY 

 

The Director of RCM Business Systems is responsible for providing leadership and strategic direction to all departments to ensure revenue goals and metrics are achieved. Provides support to RCM Leadership on technologies with an emphasis on maximizing efficiencies to all associated processes and workflows, and helps manage large-scale projects. Responsible for planning, organizing, and managing all activities related to RCM analytics, projects, systems, and practice integrations.

Applications utilized are: Microsoft Office (Excel, Word, Power Point, Access, SharePoint, OneDrive), All Eye Care Partners Patient Accounting systems, EMR, and EYECARE PARTNERS Company Email.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

 

1. Acts as strategic thought leader in the development of short and long-term goals and objectives for the company-wide Claims Management, Systems Integration, Business Process Automation and Business Intelligence functions as well as evolving away from outdated systems and business practices

     a. Prepares written goals and objectives for departmental activities and translates these into successful plans of action for self and subordinate staff.

     b. Consolidate clearinghouses in conjunction with implementation of a single billing platform and develop a team to work with both divisions to identify and create required billing/claim edits and rules.

2. Responsible for managing the Systems Integration, Claims Management,

     a. Organizes and directs the resources assigned within each department/line of business to ensure appropriate management to meet financial objectives.

     b. Serves as escalation point for all matters related to business/electronic services/reporting and automated systems processes.

     c. Ensures the “month end” process for all departments is completed in a timely manner.

 

3. Oversees approval of requested updates to certain Master Data including NextGen libraries to ensure consistency of naming, to ensure standardization of processes and reporting.

4. Works with IT PMO (Project Management Organization) to prepare and maintain required documentation for all projects.

5. Maintains lead role in all departmental system upgrades. i.e. E360+, NextGen, new vendor relationships, etc.

6. Together with the IT department and operational departments, actively participates in Clinical System upgrades to ensure no negative impact on revenue.

7. Acts as liaison between RCM and IT to ensure accurate and timely processing of billing and collection functions.

8. Keeps appraised of all HIPAA transaction set requirements and stay competent in developing the business requirements to effectively use full capabilities of all vendor and internally developed software.

9. Maintains effective liaison with all clearinghouses, payer organizations and our contracted business partners.

10. Ensures system and business internal controls are appropriately managed and in compliance with payer, business associates, federal and state contracts/regulations.

11. Ensures periodic audits of all existing bill edits and supported by most recent documentation and authorization.

12. Manages the finances of assigned responsible departments within approved budgeted parameters.

13. Coordinates activities and responsibilities with Regional and Corporate administration and staff, participating with committees and departments.

14. Develops short and long term goals and objectives that will ensure overall company accounts receivable goals are achieved.

15. Active participant in the maintenance of the all financial data, master data and billing systems.

     a. Coordinate the department’s involvement in all system testing requested by IT

     b. Assists in developing controls for system tie outs, including providing documentation to auditors.

16. Stay abreast of all reporting tools and recommend the best solutions to accomplish the reporting needs for RCM.

17. Maintains and evaluates staff according to company policy and procedures.

18. Performs all other assigned duties.

 

QUALIFICATIONS

• Bachelor’s degree (B.A.) from a four-year college or university; or 10+ years of related healthcare revenue cycle management experience and/or training; or equivalent combination of education and experience, Master’s degree in Healthcare, HIS or Business Administration preferred.
• Technical skills: Advanced Excel, SharePoint, PowerPoint and Word are necessary. Ability to perform advanced data mining from multiple sources, develop departmental SharePoint sites/subsites to support RCM departments in both reporting and workflow capacity.
• Experience with writing requests for proposals (RFP) and/or requests for information (RFI) and leading from cradle to grave projects for multiple RCM servicing Vendors (for both products and services)
• Ability to create and showcase return on investment documentation to support business decisions pertaining to people, process and technology within the RCM department.
• Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Ability to define problems, collects data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

 

NOTE:  Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time.