Director of Revenue Cycle Management - Hybrid Role

Position Summary:

The Director, Revenue Cycle Management position is responsible for the billing team management (including processing claims), credentialing, patient information management, medical coding management, billing/revenue cycle management, collections and accounts receivable management, metrics and contract management. This role will require 1-2 days per week in office (at Corporate office downtown Bay City) and the rest can be remote.

Essential Functions and Responsibilities:

This list is not inclusive; other duties may be assigned such as the key projects assigned by your manager, but will include the following:

Medical Billing (Insurance Relations) - credentialing, medical billing, accounts receivable management and contract management to achieve highest possible collectable amounts while focused on speed to cash collection. Ongoing clinic coding training and or compliance issues are also managed. The company uses all internal billing personnel employed by Mercury and does not outsource any billing, credentialing or related medical billing work.

Billing Team ManagementTrain, direct, manage current billing team and monitor workload for workload balance adjustmentEvaluate staffing levels and add billers based on processing needs. Human Resources will recruit and interview billers/staff while the manager will be included in selectingAssist with the development of creating position systems (manual) which include position requirements, expectations and training. Monitor and assist with ARs, verifications, authorizations, insurance/patient payments and patient accounts for all Renue clinics and managed service contractsManagement clearinghouse batches and rejectionsWork ARs and denials, resubmission sand appeals. Handle patient disputesProcess/set up and balance online patients paymentsManage entire collection process including submission to collection agency, adjustments, process payments to close the processBalance depositsMaintain electronic medical record (EMR)by adding insurancesMaintain medical billing software by adding insurance, EFT/ERA enrollments, providers and clinicsPrepare

BCBS/BCBSMA

deposits for CEO, COO and ControllerCredentialingManage credentialing process for all clinical staff working with all clinics. This is for all insurances both group and individual. Assist PTs with CAQH updates and maintenance and assist PTs with NPIWork with credentialing specialist on applicable credentialing software to reduce time to effectively manage submissions, process changes and periodically update recordsMedical Coding ManagementWork with clinical and evaluate and determine best in class billing methods and train clinical staff regarding CPT charges for various insurancesBilling/Revenue Cycle ManagementSee billing team management aboveStay current on insurance changes to educate patient account specialists (billers) and patient service specialists (clinic staff)Be a resource for PSS and billing staff regarding insurance and authorization questions and any end of year changesCollections and Accounts Receivable ManagementSee billing team management aboveMetrics & ReportingTrack clean claimsProcess daily, weekly and monthly reports, including month close reports and billing systemsWeekly and monthly metric reports for McLaren Caro RegionPrepare various reports for CEO, COO and Marketing as neededAnalytical WorkActivityPerformanceStaffing PlansContract ManagementMonitor insurance payments for accuracy to contractsObtain new contracts and work with other management team to improve overall performanceRelease contracts if appropriateMaintain insurance contact listDevelop relationships with the management team to improve and seek higher reimbursement rates

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required:

Proficient in all Microsoft Office applications as well as medical office software; proven experience in healthcare billing; sound knowledge of health insurance providers; strong interpersonal and organizational skills; excellent customer service skills; ability to work in a fast-paced environment.

Preferred:

A professional who has a passion to deliver great patient care and experience.

Knowledge, Skills and Competencies:

Language SkillsCommunicate clearly and distinctly when answering phones.

Communicate with people of various social, cultural, economic and educational backgrounds.

Demonstrated ability to read and interpret professional level documents written using advanced medical terminology in English.Demonstrated ability to produce clear and concise reports and correspondence at a professional level.

Communicate fluently using Standard English.

Ability to effectively present information in one-on-one and small group situations to customers, clients and other employees of the organization.

Computer SkillsDemonstrated experience using computer applications, including electronic medical records, word processing and email.