Southlake Orthopaedics
  • Hoover, AL, USA
  • Full Time

Southlake Orthopaedics is hiring a Director of Revenue Cycle Operations, a management position responsible for directing and coordinating the overall functions of the business office to ensure maximization of cash flow while improving patient, physician, and other customer relations.

The Director of Revenue Cycle Operations is responsible for carrying out supervisory duties in accordance with Southlake Orthopaedics policies and applicable laws, including interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems; scheduling staff appropriately to achieve maximum production; approving timecards and PTO requests. The Director of Revenue Cycle Operations is responsible for supervising all employees within the Billing Department.


Responsibilities and Duties

LEADERSHIP AND DEVELOPMENT

  • Apply knowledge of healthcare and database management to analyze clinical data, and to identify and report trends
  • Prepare and review billing and accounts receivables reports to ensure accuracy and efficiency
  • Analyze internal processes and recommend and implement procedural or policy changes to improve billing operations
  • Maintain compliance with CMS, OIG, and other government programs
  • Monitor and audit coding compliance related to E/M and procedural coding
  • Assure efficient processes to assure timely claims maintenance, credit resolution, payment plans, charge capture, etc.
  • Promote electronic superbill to assure expedient filing of claims each day
  • Review current status of patient accounts to identify and resolve billing and processing problems in a timely manner
  • Manage the precertification process assuring the range of precertification to assure payment of procedure
  • Implement a final eligibility process for surgeries, one day prior to surgery
  • Work with the Operations Manager to implement the tracking of physician orders to assure charge capture
  • Provide billing support to Management staff by staying abreast and communicating state, federal, and payor insurance regulation updates

DAILY / MONTHLY MONITORING

  • Open and distribute incoming mail payments
  • Prepare daily credit card report
  • Establish / monitor charge entry process for accurate and timely filing
  • Monitor payment posting for accurate and timely posting
  • Establish appropriate process to close month end
  • Reconciliation of Accounts Receivable, Collections, Bank Account, Credit Balances, Charges by provider and location
  • Prepares month end reports
  • Analyze data for trends and make recommendations for increased efficiency
  • Create front end scorecards and facilitate monthly meetings with offices to improve front end processes
  • Prepare and distribute physician report cards
  • Oversee day-to-day operations of the Billing Department
  • Ensure payment deadlines are met

OVERSIGHT

  • Ensure claims are filed with appropriate CPT, ICD-10, & Modifiers
  • Review claim notes to ensure there is appropriate documentation for claims by staff
  • Review claims submission batches and reconcile
  • Ensure rejections are worked and resubmitted for reimbursement to meet monthly goals
  • Ensure patient and insurance payments are appropriately and timely posted
  • Ensure adjustments are posted per group policies
  • Review account balances with carriers and ensure staff are resolving appropriately for reimbursement using delinquent claims report
  • Review for timely filing and collections according to insurance billing & collection guidelines
  • Monitor for monthly collection letters
  • Monitor processes for handling return checks, bad addresses and return mail for the practice
  • Monitor the handling of account calls concerning patient and insurance balances, insurance changes, patient information updates, refile insurance. information in an efficient and timely manner by staff
  • Ensure credit balances for refunds due to the patient or the insurance company are processed
  • Post all payments electronically if ERA is available, load major carrier fee schedules to assure payment of the allowable

Qualifications and Skills

  • Bachelor's degree, preferably in Business Administration or related field
  • Minimum of 5 years of medical billing management experience
  • Experience with the Greenway system
  • Excellent communication

As a member of the Southlake team you can expect:

  • Generous Paid Time Off based on years of service
  • Health & Welfare benefits starting the first of the month following your date of hire:
    • BCBS Medical
    • Dental
    • Vision
    • Company paid Life Insurance
    • Voluntary Life, Accident, Cancer, and Critical Illness coverage
    • Employee Assistance Program
  • 401(k) plan after one year of employment
  • Referral Bonus program
  • Monday - Friday schedule for most roles

You must be able to pass a pre-employment background check and drug test for employment at Southlake Orthopaedics. Any job offer will be contingent on the results of such background check and drug test.

Southlake Orthopaedics
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