Essential Job Functions
Directs the day-to-day operations that contribute to the capture, management, and collection of revenue for telehealth patient consults/visits that are members of MDLIVE’s health plan or self-insured employer clients.
Enhances and maintains revenue cycle management functions including, but not limited to, patient charges, payor follow-up, cash posting, Service Level Adjustment (SLA’s) management and resolution of denials and rejections.
Drives resolution of issues of data integrity and accuracy among key stakeholders.
Responsible for all revenue cycle functions of athenahealth, the Company’s outside billing system for consults/visits.
Establishes, evaluates, and revises operating policies and procedures to ensure compliance and effectiveness of RCM activities.
Establishes processes, metrics and monitoring systems to maximize reimbursement and cash collections.
Ensures timely activity on patient accounts receivable to maximize collections in compliance with all state and federal regulations.
Establishes and ensures implementation of all revenue cycle policies and procedures.
Establishes objectives and standards in order to measure effectiveness and quality of work and continuously improves processes, services, and systems to support organizational goals.
Manages outside audit, reporting, and special program requirements.
Advises and reports to Chief Financial Officer on AR and Cash collections, changes in procedures and requirements necessitated by both internal and external factors.
Develops and analyzes daily, weekly, and monthly productivity and financial reports; prepares reports for the Chief Financial Officer as requested.
Performs other duties as assigned.
Required Knowledge/Skills/Abilities
Expertise with athenahealth is highly preferred but, at a minimum, knowledge of sophisticated third-party, non-hospital RCM systems such a NextGen, eClinicalWorks, practice insight, Solstice, Healthcare Financial Systems, Change (Emdeon), practicefusion, or EPIC particularly in a telehealth environment.
Knowledge of and ability to add-value to the unique requirements of telehealth billing and collections for medical, behavioral health, virtual primary care, dermatology and other services including: customer eligibility and 270/271 data exchange, loading provider rosters, credentialing, multiple customer configurations, and Medicare and Medicaid billing.
Current knowledge of federal, state, and other third-party regulatory requirements, including Medicare and Medicaid.
Familiar with computer software technology available for patient billing and charge capture applications such as authorize.net and payment clearinghouses.
Effective leadership and interpersonal communications and advocacy skills including ability to effectively communicate with company and client functional staff and leaders.
Demonstrated organizational skills including ability to develop, prioritize and effectively advocate initiatives and processes while managing multiple priorities.
Excellent interpersonal skills including ability to effectively communicate, lead, and work with individuals from multiple internal functions.
Education and Experience
Bachelor’s degree in business or related field required.
Demonstrated management and supervisory skills as evidenced by minimum ten years’ experience in Revenue Cycle Management or health care billing systems with at least five years in a supervisory or management capacity.
Experience in a telehealth company is highly desired.
Experience with athenahealth is highly desired.
Capable of performing position-related physical requirements.
source https://www.jobsinmiramar.com/upper-management/senior-director-of-revenue-cycle-management-48e6577/
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Scott Smith 