Director, Revenue Cycle and Operations

The Director oversees and is accountable for all business facets of the practice, which encompasses revenue cycle and clinical business operations. The Director will supervise the daily management of the medical group concerning all elements of billing and Accounts Receivable management, as well as front office clinic operations.

The Director is tasked with the creation and execution of all policies, procedures, and standards by initiating and developing systems that influence operations to comply with all contracting, Medicaid, Medicare, and HCFA requirements. The Director will also be responsible for assembling the suitable administrative team to fulfill the objectives established for the practice group regarding revenue cycle management.

Essential Functions (Principal Duties and Job Responsibilities):

• Accountable for overseeing, directing, coordinating, and regulating all daily operations related to the physicians' billing, accounts receivable management, and clinical functions for the Meharry Medical Group and Total Health.
• Reviews and offers guidance to the contracted billing vendor or central billing office to guarantee that all provider billings are processed promptly and accurately, and that all accounts receivable are pursued in a similar fashion.
• Establishes accounts receivable policies and practices aimed at billing and collecting patient accounts and other revenue sources in a timely manner, reducing uncollectible accounts, maximizing cash flow, and preserving community goodwill.
• Develops, implements, and maintains objectives, procedures, and standards to optimize revenue; analyzes reimbursement and payment regulations for physician services to ensure compliance with HMO contracts and HCFA guidelines for teaching physicians.
• Continuously evaluates the work methods and systems impacting physician billing, offers timely and effective recommendations for workflow improvement, and executes approved modifications.
• Cultivates effective communication channels with physicians through ongoing committee and department chair meetings, a policy and procedure manual, and monthly newsletters.
• Delivers revenue cycle and financial reporting packages to the Senior Vice President of Health Affairs, Associate Dean of Business and Finance, School of Medicine, and other members of the Meharry Medical Group clinical leadership team.
• Collaborates closely with the Associate Dean of Business and Finance of the School of Medicine on quarterly Board Reports.
• Supervises educational training for physicians and their staff regarding the appropriateness of procedural and diagnostic coding.
• Ensures compliance with all legal and regulatory requirements by staying informed of changes and implementing necessary controls and/or programs to meet these requirements.
• Guarantees that the flow of data, documents, and information critical to operations is efficiently organized, coordinated, and adheres to city, state, and federal regulations. Compiles reports and conducts audits as needed.
• Prepares, reviews, and submits the annual operating budget; monitors and ensures compliance with.
• Assists faculty in preparing for managed care and risk-based contracting by providing education and developing related policies and procedures in collaboration with the leadership of Meharry Medical Group.
• Aids the Senior Vice President of Health Affairs, medical directors, MMG leadership, and faculty representatives in the creation and oversight of managed care and risk-based contracts.
• Offers support to the Senior Vice President of Health Affairs, Department Chairpersons, and Committees in formulating operational processes for the execution of clinical/medical policies, which include practice and referral guidelines, peer review standards, utilization review policies, and quality assurance initiatives.
• Collaborates with the Senior Vice President of Health Affairs to establish a working relationship with senior management staff at Metro General Hospital and other hospital systems to facilitate and coordinate billing, medical records, compliance, and physician-related issues concerning patient care and services.
• Ensures the efficient operation of all clinical front office activities, including the call center, registration, front desk exit processing, front office operations, billing, coding, medical records, and compliance.
• Oversees the implementation of training programs focused on customer/patient satisfaction, eCW utilization, coding, medical record documentation, and all pertinent policies and procedures.
• Engages in negotiations with insurance companies, external vendors, and others to guarantee that MMC secures the most favorable reimbursement/pricing on relevant contracts.
• Provides senior leadership with monthly reports (and on a need-to-know basis) that detail the financial, compliance, and programmatic status of relevant programs and services.
• Takes the initiative on additional responsibilities such as ensuring HIPAA compliance.
• Develops, implements, and sustains an operational presence that is prompt in addressing all provider inquiries, operational management challenges, and recommendations.
• Sets specific goals and objectives in accordance with the requirements communicated by Meharry Medical Group and the Senior Vice President of Health Affairs.
• Keeps abreast of current medical trends and advancements in physician practice management and managed care; fosters relationships with counterparts in affiliated organizations to enhance quality, financial performance, information systems, and operational management.
• Ensures open communication and information exchange through regularly scheduled individual and group staff meetings, committee meetings, and faculty meetings.
• Conducts necessary reviews, analyses, and evaluations to confirm that operations are fulfilling the needs and requirements of the physician, medical college, hospital, and contracted health plans.
• Guarantees that all divisional directors, managers, clinic staff, and faculty are well-informed about significant policies and procedures, revenue cycle, medical records, and the outcomes of actual operations. Maintains close communication with the Associate Dean of Business and Finance for the School of Medicine, Senior Vice President of Health Affairs, Medical Director of Meharry Medical Group, and relevant leadership at Meharry Medical College.
• Engages in business operations and personnel hiring, conducts written performance evaluations, and assists in resolving complex employee relations issues.
• Develops, implements, and maintains written job descriptions that include standards for evaluating each job classification, and performs written assessments of employee performance based on responsibilities and performance targets outlined in the job description.
• Interviews candidates and recommends new hires; prioritizes schedules; formulates corrective action plans and disciplines in accordance with the organization's established rules, policies, and procedures.
• Approves requisitions for supplies, equipment, and other items essential for proper operations.
• Performs related duties and other tasks as assigned.
• Ensures that employee turnover is kept to a minimum.
• Implements state and federal regulations on clinic records management.
• Arranges for HIPAA, OSHA and risk seminars in conjunction with Human Resources.
• Plans, organizes, directs, monitors, and supervises the daily workflow of the Medical Coding Department to ensure the accurate assignment of ICD·9 ICD-10, CPT-4 and physician charges and month end closing standards for the facilities are met, and that staff productivity is maintained according to established standards.
• Ensures assigned staff is meeting expected quality and quantity levels in the application of Team Health Billing and Coding Guidelines, Coding work file, DMS, NEIC edits, Provider reports, etc.

                                                                                                               

Knowledge, Skills and Abilities Required:

• Strong background in financial management and knowledgeable of federal and state laws and requirements relating to healthcare management required.
• Strong managerial competencies in the areas of leadership and team development, managerial coaching and mentoring and situational assessment skills and with proven track record in building and developing high performing teams required.
• A change agent and capable of guiding the organization in initiating various change management initiatives with the view of leading and guiding the organization towards the future required.
• Strong managerial acumen in setting corporate directions and aligning strategic goals around business plans required.
• Superior judgment, negotiation and decision-making skills required.
• Strong ethics and a high level of personal and professional integrity required.
• Strong analytical skills and adept in interpreting strategic vision into an operational model required.
• An effective communicator at all levels in the organization, with strong oral, written and persuasive skills required
• Ability to generate financial reports for executive management.

          Knowledge, Skills, Abilities Preferred:

Education and Experience Required:

• Minimum of 5 years’ experience in health care management such as but not limited to clinic management, patient management, accounts receivables and payables, and coding required.
• Bachelor’s degree in health care administration, business or another related field required.
• Advanced knowledge of ICD-9
• Working knowledge of ICD-10

Education and Experience Preferred:

• Master’s Degree in health care administration, business or another related field

Licensure, Certification or Registration Required:

Licensure, Certification or Registration Preferred:

• Certified Professional Coder Certification preferred.
• Certified Revenue Cycle Representative Certification required.

This job description reflects the general duties and responsibilities necessary to describe the principal functions of the job, as identified, and shall not be considered an exhaustive list of job responsibilities which may be inherent in the job. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. The responsibilities listed may be subject to change at any time and individuals may be asked to perform duties outside of their regular responsibilities to support the ongoing operations and mission Meharry Medical College and its facilities.