The Director – Revenue Cycle Management for Collections is responsible for the successful operation of the CareCentrix Revenue Cycle Claims Operations team through leadership and oversight of all operational elements with policies & procedures, escalations, cash collections, and general reimbursement functions with our health plan clients. The position is responsible for leading the operational unit that works with internal and external stakeholders to ensure that all carrier revenue is appropriately collected from the health plan or the provider reimbursements recouped.
• Directs reimbursement functions for all claims billed to our payers including traditional home health (nursing), home medical equipment, sleep services, and infusion therapy claims from third party providers as well as CareCentrix providers. Responsible to meet all accuracy and turnaround time requirements, document requirements and timely filing requirements, internally and externally established.
• Develops, organizes and implements overall billing, collection and payment reimbursement functions.
• Evaluates department functions to increase positive cash flow, achieve operational efficiencies, and ensure compliance with established laws, regulations, and CareCentrix policies and procedures.
• Optimizes the collection of Health Plan AR balances for designated system platforms, including Blue card and non-Blue Card products.
• Monitors and audits productivity goals, reviews level of progress and achievement, and exercises discretion and judgment when recommending and implementing measures for improvement.
• Monitors all reimbursement results, anticipates and avoids problems and proactively identifies and investigates new or emerging issues that may impact CareCentrix or corporate financial results.
• Ensures timely and accurate claims processing within the Revenue Cycle Management. Defines and implements quantitative performance measures to establish performance objectives and continuously raising performance standards.
• Acts as a Business SME and a liaison capacity with other areas and business units to implement and communicate business strategy as it relates to RCM Health Plan Audits.
• Analyzes reports to identify areas of concerns, trends and issues across entities that are impeding customer service. Collaborates with internal partners to develop process improvement initiatives to reduce defects, improve overall operating efficiencies and maximize revenue.
• Hires, develops and leads an outstanding management team.
• Ensures appropriate staff training, cross training, evaluates staff performance and recommends hiring, terminations, promotions and salary action.
• Establishes monthly goals for each team within the operations centers and evaluates performance, e.g. day’s outstanding, operating costs, and reimbursement percentages.
Bachelor’s Degree in Business, Health Care, Public Administration or the equivalent preferred, plus a minimum of six years of progressive responsibility managing health care claims payment operations and health care claims billing and reimbursement operations, including at least five in a managerial role generally required. Five or more years of BlueCard claims billing, collections and accounts receivable management also required. Will consider candidates with over a decade of equivalent business process and people management experience directly in health care claims and reimbursement operations. Requires knowledge of medical coding terminology and application to health claim forms (“claims”), accounts receivable management and collections experience, strong financial acumen, and the ability to lead engagement with internal and external stakeholders to facilitate closure of outstanding accounts receivables.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.