Director of RCM & Patient Access

Allergy & ENT Associates is looking for a Director of Revenue Cycle Management and Patient Access at our Central Office in North Houston, TX!

What are we about?

As a multi-state, physician-led team of specialized providers and dedicated staff, we are focused on enhancing the well-being of our patients living with allergy, asthma, and sinus conditions. Our mission is simple: to empower individuals to embrace life to the fullest through personalized, comprehensive, and compassionate healthcare.

Benefits

Health Insurance

Dental & Vision Insurance

401K

Life insurance

PTO & Holidays

Short- & Long-Term Disability

Position Summary

We're seeking an accomplished leader with an outstanding track record in healthcare billing operations and team leadership to serve as the Director of Revenue Cycle at Allergy & ENT Associates, a multi-state, multi-practice operation that sets the standard for patient care.

As the Director of Revenue Cycle, you'll leverage your business acumen to provide strategic guidance to our centralized billing office, overseeing all billing operations and applications while furnishing critical data for strategic initiatives. Collaboration across various departments and effective communication with external stakeholders will be paramount, underpinned by a steadfast commitment to industry standards and the optimization of revenue cycle processes.

Reporting to the CFO, you'll collaborate closely with the Accounting/Finance departments to ensure accurate financial reporting. Spearheading the establishment of performance benchmarks and close monitoring of payer regulations will also fall within your purview. Our team will rely on your collaboration in developing management policies, fortifying compliance measures, and developing and implementing revenue cycle protocols to uphold federal and state regulations. We seek a team builder who supports others to be their best!

An extensive knowledge of revenue cycle management, coupled with organizational prowess, will position you as a cornerstone of our team. If the prospect of playing a pivotal role in the dynamic realm of healthcare at Allergy & ENT Associates is appealing to you, we'd love to hear from you.

This role is located in Houston, TX, with the possibility of hybrid and/or remote work arrangements and potential light travel to our other markets.

Essential Duties & Responsibilities

• Help develop, promote, and maintain a corporate culture that supports the mission and values of Allergy & ENT Associates.
• Provide direction to Revenue Cycle Management (RCM) management team to ensure accurate and timely billing and collection of all services and related recording of charge, payment, and adjustment transactions.
• Provide directions to Revenue Cycle Management (RCM) management team to ensure accurate and timely coding and charge posting of all hospital and facility services, including surgeries and minor procedures.
• Provide direction to Revenue Cycle Management (RCM) management team regarding denials and appeals processes for unpaid and underpaid third-party claims.
• Provide direction to Revenue Cycle Management (RCM) management team pertaining to refund and take-back processes for overpaid claims by third-party payers and patients, with approval and processing by Finance.
• Provide direction to Revenue Cycle Management (RCM) management team on the resolution of self-pay balances on a timely basis, including approval at write-offs and discounts and placement at bad debts with collection agencies.
• Provide direction to department staff on problem claims, unresolved account balances, and payer issues.
• Collaborate with leadership in other revenue-related departments (Patient Access, Operations, Information Systems, Finance, etc.) to improve revenue cycle process efficiency and effectiveness.
• Manage the recruitment and retention of a high-performing RCM and Patient Access workforce in conjunction with Human Resources.
• Measure Department and associate performance and implement performance improvement and coaching as needed. Complete annual, or more frequently as needed, associate Performance Review and Development Plans on a timely basis. Manage associate termination when appropriate.
• Maintain knowledge and understanding of relevant business office compliance requirements sufficiently to maintain compliance and identify and resolve issues that arise.
• Monitor policies and procedures to ensure accurate and complete billing of all services. Develop new forms, policies, and processes as needed. Monitor status in the practice management system to ensure services are billed in a timely manner.
• Periodically review provider E&M coding patterns and report results to leadership team.
• Oversee the maintenance of applicable system setup tables in practice management systems and related software systems (e.g. insurance carrier tables, payer fee schedules, etc.}.
• Manage the updating of CPT, ICD10, HCPCS, RVUs, and quality codes in the billing system annually. Update all billing documents for any code changes annually. Update EMR case categories as needed.
• Work with EMR System Admin team to create and maintain all coding edits for the practice management system.
• Provide direction to credentialing team for new and existing physicians and mid-level providers.
• Oversee the negotiation, creation, and management of contracts within the healthcare industry.
• Ensure compliance with laws and regulations governing healthcare contracts.
• Review and analyze contract terms and conditions.
• Collaborate with internal departments to ensure contract terms meet organizational needs.
• Monitor contract performance and compliance.
• Keep abreast of changes in the healthcare industry that may impact contracts
• Act as liaison for third-party payer representatives, billing vendors, and external contacts.
• Oversee and provide direction to RCM management for responses to payer audit requests, reviewing
• and/or compiling chart documents to be sent.
• Maintain effective working relationships with all Allergy & ENT associates, hospital and referring
• physician staff, managed care and government payer representatives, and vendor representatives.
• Manage staffing based on daily activities and workflow.
• Serve as a revenue cycle resource to physicians, managers, and associates, providing formal and informal education, as needed.
• Collaborate with leadership team to establish and implement Allergy & ENT Associate's strategic plan and manage issues that arise.
• Identifies opportunities and takes action to build strategic relationships between one's area and other areas, teams, departments, and units to achieve business goals. Drives the promotion of teamwork within and between departments, participates and/or leads and facilitates department process improvements as needed.
• Manage Department operating and capital expenditures versus budget.
• OptIm1ze the structure of department's workflow and staffing.
• Monitor and report on-revenue cycle KPIs and drive continuous performance against targets.
• Contribute to department and organizational effort by performing other duties as assigned.
  
  

Qualifications

Education & Experience

• 7+ years of experience in healthcare or third-party payer plans
• 5+ years of progressive management in a healthcare setting
• Expert knowledge of revenue cycle management and Medicare/Medicaid billing
• Degree in Accounting, Finance, Business Admin or Healthcare preferred
• Proficiency in Nextgen EHR/PM preferred
  
  

Knowledge, Skills, Abilities

• Customer Service — Knowledge of principles and processes for providing customer service; the ability to demonstrate a series of activities designed to enhance the level of both internal and external customer satisfaction.
• Organization — Uses time efficiently by prioritizing and planning work activities; is methodical and efficient in structuring tasks to be accomplished.
• Professional Maturity — The ability to separate emotional feelings from the real issues at hand. The ability to legitimately and objectively challenge the substance of our beliefs and biases of our observations.
• Time Management — Managing one's own time and the time of others; the ability to shift back and forth between two or more activities or sources of information (such as speech, sounds, touch, or other sources).
• Active Listening — Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
• Interpersonal Communication — Writes and speaks effectively based on the psychological, relational, situation, environmental and cultural dynamics within the situation
• Communication — The ability to write and speak effectively using appropriate convention based on the situation; actively listens to others, asks questions to verify understanding, and uses tact and consideration when delivering feedback to others.
  
  

Work Environment

Well-lighted, heated and/or air-conditioned indoor office setting with adequate ventilation; Moderate noise (examples: business office with computers and printers, light traffic), daily stair climbing; Typical schedule is Monday through Friday with regular working ho urs; Occasional overtime may be required.