DIR REVENUE CYCLE

Overview

Director of Revenue Cycle, CMG Business Office

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times. 

Position Summary:

This position works under the direction of the Covenant Medical Group (“CMG”) Chief Financial Officer.  Responsible for providing leadership, direction, growth, and administration of CMG’s revenue cycle functions, which includes but is not limited to: timely pre-bill edit resolution and claims transmission; transaction posting (receipts, adjustments, timely identification and resolution of discrepancies); accounts receivable, denials, and underpayments management; self-pay/uninsured billing and collections; and internal and external customer service. Also, in close coordination with CMG Operations Managers and individual practice management:  Patient access, registration, check-out, charge capture/coding and timely entry of same. Responsible for the direction of activities related to the analysis and design of strategies and systems to effectively manage patient accounts receivables and to achieve appropriate reimbursement from third party sources, patients, and other collection efforts/resources.  Must plan, organize and direct the activities to ensure control and management of the individual revenue cycle functions and overall revenue cycle performance.  This role requires working in a highly collaborative and consistent manner with physicians, practice management and staff, corporate staff, both existing and those joining CMG.  This position is invested in the business of the patient visit and is responsible for overseeing the Central Business Office (“CBO”), charge capture / coding, working closely with the CMG compliance officer, and the centralized coding group.

Recruiter: Suzie McGuinn || [email protected]

Responsibilities

• Responsible for the CBO and its processes. Requires the ability to manage technical and support staff while working with a sophisticated information technology platform. 
• Determines the appropriate structure for key function areas in the business office such as claims processing, payment posting, and payer specific third-party follow-up and reporting analytics.
• Develops and implements procedural and staffing changes as needed that result from A/R analyses, payer requirements, customer needs, and technology changes.
• Responsible for developing and maintaining a formal audit process to monitor and track the accuracy of the revenue cycle process. This information will be used as a benchmark tool for quality improvement and to identify staff education opportunities.
• Ensures fee schedules, as negotiated with payers, are loaded into the billing system. Monitors error reports when payments do not match the fee schedule and ensures staff follow-through until the correct payment is received.
• Works closely with the CFO to evaluate new technology and implement best practices to maximize the efficiency of the revenue cycle, and implement appropriate strategies to enhance CMG’s cash position, processes, quality, and customer service (both internally and externally).
• Stays abreast of new technologies, processes, and best practices that will assist in daily operations of revenue cycle performance. Ensures that available automation is well utilized, and that staff are well-trained on existing systems.
• Creates and monitors key revenue cycle performance reports for all practices. Works closely with the Operations Manager and Practice Manager to resolve any issues.
• Analyzes results of cash collections, accounts receivable management, and other revenue cycle indicators, and uses the information to target areas for process improvement. Consistently shares results with practice staff and management and communicates the results and needed improvement activities to the CFO and CMG leadership team.
• Handles the more difficult and complex issues and problems that arise routinely within responsibility area. Examples include Physician practice issues, payer delays, patient complaints, serious computer problems, legal issues, regulatory involvements, patient complaints, etc.
• Works closely with the other members of CMG operations team to ensure collaboration with physicians, practice managers, and other clinical operations staff where functions intersect with the business process and other revenue cycle operations.
• Develops and maintains policies, procedures, and how-to guides related to the revenue cycle functions. Consults with the CFO concerning recommendations for policy revisions and/or new policies and procedures. Ensures appropriate staff training and internal controls are in place and adhered to at all times (adjustments, refunds, cash postings, cashiering, etc.). 
• In conjunction with the CFO, coordinate with the health system, ensuring that the two processes of hospital and professional billing are appropriately coordinated and that system policies are consistently applied.
• Works closely with the Corporate centralized coding group and the Corporate audit group to ensure that any claims are reprocessed and any refunds are made in compliance with current rules and regulations.
• Works closely with Covenant’s Vice-President and Director(s) of Patient Accounting, regarding consistency in Policy and Procedures, processes, etc., as applicable.
• Ensures continuing compliance with State and Federal regulations as they relate to the revenue cycle continuum.
• Works with the practice managers/administrators to facilitate improvements in office practice systems and procedures related to the revenue cycle, coding/charge capture, and compliance.
• Evaluates and trains appropriate management and staff members regarding the collection of data for month-end reporting. Ensures month-end reporting data collection is consistently on time and accurate.
• Centralize charge entry and coding, where applicable, and ensure charges are entered accurately and timely.
• Provides leadership and direction for transitioning the revenue cycle piece of non-aligned practices to CMG; responsible for the execution of practice start-up plan to ensure that every step in transitioning the practice is undertaken successfully.
• Remains current on procedural and regulatory changes issued by Medicare, TennCare, managed care payers, and agencies. Communicates updates to staff and other departments that need to know.
• Ensures continuing compliance with State and Federal regulations as they related to the revenue cycle functions.
• Assists with preparation and monitoring of annual operating budgets related to the revenue cycle functions. Maintains resource utilization within the established budget.
• Develops and monitors the CBO key indicators of performance.
• Establishes and maintains exemplary communications and working relationships with the other members of CMG, its physicians, practice management and staff, and the Covenant Health Management team.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

Minimum Education:           

Bachelor’s Degree required or equivalent education and experience applicable to and necessary to fulfill duties of the position.

Minimum Experience:         

Knowledge of Medicare, Medicaid, and third-party payers, rules and regulations.  Registration experience, which includes insurance verification, precertification, and financial counseling also required.  Minimum of five (5) years' experience in physician practice or equivalent.  Through subordinate managerial or supervisory staff, responsible for the planning, coordinating, and directing of all revenue cycle service activities and personnel on a daily basis.

Licensure Requirement:    

   None.