Director of RCM, Financial Clearance (Phoenix)
Revenue Cycle Management
- Posted: 14 October 2020
- Phoenix, AZ, USA
At American Vision Partners (AVP), we’re bringing the best together. Our company was created with the affiliation of Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, and the M&M Eye Institute. Today we’re one of the nation’s largest and most comprehensive ophthalmology practices with more than 45 eye care centers in Arizona and New Mexico - including 24 ambulatory surgical centers. At AVP we are committed to best in class patient care, being a pioneer in research and technology and most importantly, rewarding and recognizing our employees!
Director of RCM- Financial Clearance
American Vision Partners- Phoenix Biltmore
As a Director of RCM- Financial Clearance, you’ll oversees the functions of the patient collections, authorizations, cash applications and credit balance revenue cycle teams to ensure effective management of receivables and efficient functions of the revenue cycle. Ensures appropriate collection measures are in place for patient balances, surgical authorizations are received timely and all payments are accurately posted.
- Responsible for oversight of patient collections and financial counseling, insurance authorization, cash applications and credit balance teams. Lead day-to-day operations and broad scoped work assignments focused on maximizing quality and production processes.
- Develops new approaches to streamline existing processes, reorganizes work, and improves resource utilization for cash applications, insurance verification and patient collections teams.
- Develop reports to track key performance indicators and monitor and manage overall patient collection performance.
- Monitors and identifies processes to be implemented in order to achieve key revenue cycle metrics including but not limited to cash collections, unbilled A/R, aging over 90 days, and Days in AR. .
- Performs ongoing trend analysis on patient payment levels and denial rates to ensure that reimbursement is in accordance with allowable amounts stated in agreements and contracts. Minimizes contractual and bad debt write offs. Works collaboratively with outside collection agencies to ensure maximum collection efforts.
- Closely monitors denial trends and researches root cause issues while developing solutions to improve overall denial metrics. Collaborates with internal customers to mitigate denial creation.
- Analyzes month end reports to identify opportunities for process improvements with respect to claims denials and outstanding patient A/R.
- Oversees management team to ensure that productivity and accuracy audits are being performed, department policies are followed and administered fairly. Ensures that all staff is being held accountable for performance.
- Ensures that all payment posting is accurately posted and that effective balancing processes are in place and consistently followed.
- Responsible for ensuring credit balance thresholds are met and processes are followed according to internal policies.
- Resolve complex payer or physician issues when necessary. Act as a primary point of escalation contact for clinical operations for day to day operational issues relating to billing, collections and denials.
- Maintains comprehensive knowledge of payer billing requirements and reimbursement policies.
- Communicates performance data and action plans to leadership.
- Monitor, assess, and measure the financial impact on the organization of prospective regulatory changes to Federal and State reimbursements.
- Identify opportunities to maximize reimbursement.
- Performs other duties as assigned. Maintains strict confidentiality.
- Conducts self in accordance with the company’s standard values and policies.
- Participates in a variety of educational programs, corporate and professional, to maintain current skill and competency levels.
- All other duties as assigned
- BA degree in Healthcare Administration, Business Administration, or related strongly preferred. HS diploma and equivalent experience required.
- Minimum five years in a leadership role within a healthcare revenue cycle department.
- Previous management experience with strong leadership skills and an ability to motivate others with a positive attitude.
- Leadership capability and proven successful experience in managing large revenue cycle teams.
- Demonstrated experience managing to key performance indicators including experience routinely reporting metrics and managing a team to meet defined metric based goals.
- Advanced ability working in Excel (advanced formulas, pivot table), PowerPoint, Word and Outlook.
- Experience working with NextGen practice management is preferred.
- High school diploma or GED required. BA/BS in Business Administration, Account, Finance or equivalent is preferred.
- Active knowledge of CMS guidelines, contracted insurance guidelines and coding policies.
- Advanced PC skills; MS Access, Excel, PowerPoint, Word and Outlook.
- Well-organized with attention to detail
- Ability to read and understand oral and written instructions
- Critical and analytical thinking skills to conduct compliance audits and draft reports.
- Written and verbal communication skills required.
- Ability to organize workload, manage multiple projects, and maintain confidentiality of all work information
- Strong analytical and problem solving skills with the ability to define root causes of concerns as they arise.
- Ability to establish and maintain effective working relationship with team members, clinic staff, payers and patients.
- Have a desire and dedication to work with self-discipline.
- Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations.
Benefits & Perks:
Your health, happiness and your future matters! At AVP, we offer everything from medical and dental to significant eye care discounts, continuing education, 401(k), 9 paid holidays plus PTO, flexible work hours and much more!
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.