Bachelor's degree in Business Administration, Accounting, Finance, or other health care discipline required. Master's Degree in Business or Health Administration ideal.
Extensive knowledge of medical reimbursement, billing, coding and compliance regulations is required.
7 + years leadership experience with a minimum of 5 years leadership experience in Revenue Cycle Management / Claims Management / experience within a Clinical / Anatomic Laboratory or provider organization.
Experience managing staff of 20+ employees ideal.
Extensive knowledge of the revenue cycle management function and have in-depth knowledge of billing processes to include, but not limited to: Billing Data Entry, Billing Exception Processing, Claims Submission (837 electronic claim submissions), Clearinghouse Process, Remittance / Cash Application (835 electronic remittance), Cash Collections, Accounts Receivable Management, and Appeal Processes.
Knowledge of out-of-network and managed care reimbursement techniques.
Proven ability to work well with and influence peers, sales teams, and management.
Experience presenting to and working directly with C-level executives and work team.
Oversees the medical billing operation for the Company to allow for maximization of revenue while ensuring compliance with all pertinent company and regulatory requirements, policies and guidelines.
Identify opportunities to contract with payers and execute in-network agreements
Develops and defines department goals, procedures and objectives. Develops and monitors revenue cycle performance metrics to drive continuous improvement efforts in all areas of the revenue cycle providing regular updates to senior management to ensure prompt attention to areas of concern.
Monitors all major internal and external issues impacting billing, ensuring appropriate actions are taken to address identified issues and providing guidance and expertise as necessary to ensure an effective and compliant resolution.
Contributes to the compliance with, and development and updating of, department standard operation policies and procedures by:
Ensuring current knowledge of industry best practices and their applicability to Company.
Ensuring all financial procedures for accounts receivable and billing personnel are followed.
Ensuring accounts receivable and billing group personnel are appropriately trained according to regulatory policies and procedures.
Ensures identified audit and compliance issues are addressed and corrected.
Ensure development and training of all Revenue Cycle personnel in accordance with Company policies and procedures.
Oversee all departmental staff as assisted by team supervisors, including hiring, training, coaching and discipline.
Continuously monitors evolving medical policy and coverage determinations made by insurance carriers.
Share evolving Revenue Cycle Management related trends with leadership.
Actively participates in the monthly Compliance Committee meetings.
Ability to lead and develop a team.
Ability to communicate with the Executive Team as needed and build effective relationships across all functions of the business.
Positive attitude with a customer service mentality toward internal & external stakeholders.
Excellent cross-functional team participation skills.
Highly organized and detail-oriented.
Results and goals oriented.
Ability to work in a fast-paced and changing environment; flexible and quickly adaptable to changing priorities.
Effective personal communication skills, shares knowledge with excellent training skills.
Passionate for both personal and corporate success.
Excellent technical understanding and analytical ability.
Commitment to integrity and quality, with a strong work ethic.