Preferred jobs - 35 jobs

SUMMARY: The Director of Revenue Cycle Services is responsible for the overall strategic leadership and operational management of Preferred Management's network of hospitals revenue cycle functions. This role oversees all areas from patient access to final payment, ensuring accuracy, compliance, and efficiency. The Director drives system-wide performance improvement, leads a high-performing team, and partners with clinical, administrative leaders, and the Home Office team to maximize reimbursement, reduce denials, and support the financial stability of all hospitals in the Preferred Management network. ESSENTIAL DUTIES AND RESPONSIBILITIES: Provide strategic leadership for all hospitals' revenue cycle functions, including Patient Access, HIM, Charge Capture, Coding, Billing, Denials Management, and Collections. Oversee and optimize Meditech system workflows within revenue cycle modules to improve accuracy, efficiency, and reporting. Develop, implement, and monitor key performance indicators (KPIs) such as AR days, DNFB, denial rates, clean claim rates, and cash collections. Ensure timely and accurate submission of all claims, both governmental and commercial, while minimizing rejections and denials. Lead initiatives to reduce denials through improved documentation, coding accuracy, and payer communication. Maintain a compliant and accurate Charge Description Master (CDM) and support correct charge capture across all departments. Collaborate with clinical leaders to support accurate documentation and alignment with regulatory and compliance requirements. Direct the implementation of revenue cycle policies, procedures, and best practices to ensure consistency and operational excellence. Partner with Compliance and HIM to ensure adherence to CMS guidelines, HIPAA regulations, and all applicable billing and documentation laws. Analyze payer trends, reimbursement issues, and claim disputes to identify root causes and drive corrective action plans. Prepare and present regular financial and operational reports to executive leadership, identifying risks, opportunities, and strategic recommendations. Oversee vendor relationships, including clearinghouses, collection agencies, consulting partners, and revenue cycle technology providers. Lead, mentor, and evaluate revenue cycle leadership and staff, fostering a culture of accountability, teamwork, and high performance. Coordinate training programs to ensure staff competency in Meditech workflows, billing rules, compliance requirements, and revenue cycle processes. Support month-end closing by ensuring timely charge posting, reconciliation, cash balancing, and reporting accuracy. Conduct audits of revenue cycle processes to identify errors, inconsistencies, and opportunities for improvement. Work with IT and Meditech teams to enhance reporting tools, automate processes, and improve system capabilities. Serve as the primary escalation point for complex billing, payer, or patient financial issues requiring senior-level intervention. Lead cross-departmental projects aimed at improving the financial health of the organization and optimizing revenue capture. Stay current on changes in healthcare regulations, payer guidelines, coding updates, and industry best practices. Overnight travel to Preferred Management hospitals to assist with training, workflow processes, compliance, and reimbursement. SUPERVISORY RESPONSIBILITIES Directly supervise revenue cycle leadership and management staff, including hiring, training, coaching, and performance evaluation. Provide mentorship and professional development opportunities for staff to enhance team performance. Establish clear goals, expectations, and performance metrics for all revenue cycle departments. Promote a culture of accountability, teamwork, and continuous improvement. Manage workflow assignments, staffing schedules, and department resources to meet operational objectives. Conduct disciplinary actions when necessary, in compliance with hospital policies and regulations. Requirements QUALIFICATIONS: Extensive knowledge of hospital revenue cycle operations, including patient access, insurance verification, coding, billing, charge capture, denials management, and collections. In-depth understanding of Meditech Expanse and Business & Clinical Analytics (BCA) revenue cycle modules, workflows, reporting functions, system optimization, and data extraction. Strong knowledge of Charge Description Master (CDM), ICD-10, CPT, and HCPCS coding guidelines and how they impact reimbursement. Comprehensive understanding of payer rules and reimbursement methodologies, including Medicare, Medicaid, commercial payers, managed care plans, and value-based arrangements. Knowledge of federal and state healthcare regulations, including CMS billing guidelines, HIPAA, EMTALA, and compliance standards involved in revenue cycle operations. Familiarity with charge capture processes, including documentation requirements and regulatory billing compliance. Strong understanding of clinical documentation integrity (CDI) and its impact on coding, quality scores, and reimbursement. Knowledge of contract management, payer agreements, claim adjudication processes, and appeal strategies. Proficiency with revenue cycle analytics, KPI monitoring, and financial reporting, including AR days, DNFB, denial rates, cash flow, and reimbursement trends. Knowledge of customer service standards related to patient financial communications, billing inquiries, and resolution processes. EDUCATION and/or EXPERIENCE: Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field preferred. In lieu of a Bachelor's degree, at least 10 years experience working in a hospital Revenue Cycle setting is preferred. Minimum 5 years of progressive management experience in a hospital Revenue Cycle setting. Experience with Meditech Expanse preferred; experience with Electronic Health Records systems and analytic tools required LANGUAGE/READING SKILLS: Strong verbal communication skills to clearly present financial and operational information to executive leadership, staff, and external stakeholders. Ability to write policies, procedures, reports, and correspondence in a clear and professional manner. Skilled in delivering presentations, training sessions, and workshops for diverse audiences. Ability to effectively communicate complex financial concepts in understandable terms. Ability to foster collaborative relationships across departments and with external partners. MATHEMATICAL SKILLS: Ability to analyze financial data, revenue cycle metrics, and statistical reports to identify trends and variances. Proficiency in calculating percentages, ratios, and complex financial formulas related to reimbursement, AR aging, and cash flow. Strong skills in interpreting and forecasting revenue, budget performance, and financial outcomes. Ability to perform calculations related to payer reimbursement methodologies, contractual allowances, and expected payments. Competence in analyzing large data sets and converting numbers into actionable insights. Ability to calculate productivity standards, staffing ratios, and workload metrics for revenue cycle departments. Skilled in comparing financial results against benchmarks, targets, and prior performance. Capability to develop and interpret dashboards, KPIs, pivot tables, and other quantitative reports. Strong understanding of statistical concepts used in performance improvement and root-cause analysis. Ability to prepare financial models that support decision-making, planning, and revenue cycle strategy. REASONING ABILITY: Ability to analyze complex revenue cycle problems and identify root causes. Skilled at evaluating multiple options and determining the most effective solution for operational and financial issues. Capable of interpreting regulations, policies, and payer requirements to make informed decisions. Ability to apply critical thinking to identify trends in data and develop actionable strategies. Skilled at forecasting outcomes and anticipating challenges in revenue cycle operations. Ability to integrate financial, operational, and clinical information to support strategic planning. WORK ENVIRONMENT: Employee is regularly required to stand, walk, sit, ascend and descend stairs, possess ability to handle, finger or feel objects, tools or controls; reach with hands and arms. Employee must frequently be able to lift 25 pounds from the floor to waist level. Specific vision abilities include close vision and the ability to clearly focus vision.