Associate Director of Revenue Cycle Optimization

POSITION SUMMARY

Supports the VP of Revenue Cycle Operations and Optimization in managing aspects of revenue cycle optimization, including maintaining relationship and monitoring of third-party billing organization and EPIC hosting organization, identifying and implementing revenue optimization strategies, regulatory compliance with third-party insurers (Medicaid, Blue Cross/Blue Shield, etc.), and maintenance of billing and reporting systems.  Collaborates with the VP of Revenue Cycle and Optimization in preparing, reporting on and ensuring compliance of fee schedules, contracts and credentialing activities for managed care contracts. Supports the VP of Revenue Cycle Operations and Optimization in leading strategic revenue cycle optimization initiatives that improve financial performance, operational efficiency, and regulatory compliance. Supports VP of Revenue Cycle Operations and Optimization with third-party Revenue Cycle Management (RCM) vendors and Epic managed services partners, identifies opportunities to optimize revenue, improve reimbursement, reduce denials, and enhance billing operations. Collaborates with clinical, operational, finance, information technology, and payer stakeholders to strengthen revenue integrity, reporting, reimbursement accuracy, and overall revenue cycle performance.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES 

Management (10%) 

• Recruits, retains and develops a diverse and highly qualified staff; provides ongoing performance feedback and maintains a safe and professional work environment
• Evaluates staff in a timely manner in accordance with PPGNY’s policies. Completes performance evaluations, goal setting, and corrective action processes in accordance with PPGNY policies. Partners with Human Resources and Revenue Cycle leadership on recruitment, onboarding, succession planning, employee engagement, and staff retention initiatives.
• Performs other leadership, training, mentoring, and operational support responsibilities as assigned.
•  Promotes accountability, continuous improvement, operational excellence, and a culture of collaboration through effective leadership and mentoring.

Revenue Cycle Optimization and Revenue Cycle Liaison (55%)

• Performs analysis of revenue cycle trends to identify opportunities to prevent denials, optimize reimbursement, improve first-pass claim acceptance, and maximize cash collections.
• Performs root cause analysis of revenue cycle issues, develops corrective action plans, and implements process improvements to enhance revenue performance and operational efficiency.
• Develops, executes, and manages work plans through completion, including billing corrections, reimbursement optimization, appeals, and workflow improvements. Partners with the Epic managed services organization and Information Technology to implement automation and system enhancements whenever possible.
• Collaborates with third party RCM vendor to implement process changes
• Collaborates with cross-functional teams to ensure alignment between clinical operations, revenue cycle workflows, payer requirements, and PPGNY billing practices.
• Tracks adherence to implemented process changes, measures key performance indicators, and quantifies financial outcomes to ensure sustained operational improvements.
• Monitors and reports key revenue cycle performance indicators including cash collections, days in accounts receivable, denial rates, clean claim rates, charge lag, timely filing, and underpayment recovery.
• Monitors Health Centers’ adherence to charge reconciliation processes and key performance indicators, partnering with Health Center leadership to address trends, improve compliance, and optimize revenue performance.
• Ensure changes within the charge description master (CDM) coincide and are implemented within clinical systems
• Review changes in CPT®, HCPCS, and revenue codes for accuracy, compliance with applicable billing guidelines, and optimization of reimbursement
• Identifies opportunities to automate manual revenue cycle processes through Epic optimization, workflow redesign, reporting enhancements, and collaboration with Information Technology and vendor partners.

Monitoring Tools (25%)

• Provides guidance to the Senior Data Analyst in the development and implementation of reporting tools to identify revenue cycle trends, including root cause of denials.
• Supervises the building of reporting tools (and periodically builds the reports directly) to monitor productivity and quality of work performed by staff that impacts RCM results, including front desk, financial counselors, and third party RCM vendor.
• Works closely with Data Analytics team to develop dashboards, scorecards and other tools to monitor performance.

Education and Training (10%)

• Develops and delivers training, or partners with appropriate departments to provide education, on revenue cycle processes, system enhancements, regulatory requirements, and operational best practices for Revenue Cycle and operational staff.
• Maintain up to date knowledge of CMS billing rules and payer requirements to proactively identify policy changes
• Remain current on Epic reporting tools