The Director of Professional Fee Revenue Cycle is responsible for managing the overall functions of the University of Maryland Community Medical Group’s professional fee revenue cycle to ensure maximization of revenue and cash flow while maintain the highest levels of patient, physician, employee and other customer relations. This includes management oversight of all business related functions of the patient visit from point of entry to accurate adjudication of the patient’s account. Specific areas of responsibility include registration, billing and collections, patient insurance data processing, denials management, integrity of patient accounts and accounts receivable management.
The Director of Professional Fee Revenue Cycle is responsible for the direction of these efforts together with the physician offices to ensure the accuracy and timeliness of registration, charge capture, charge entry, claims submission, follow-up and account adjudication.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1. Plan and direct pre-verification of patient insurance, registration, billing and collections, and data processing to ensure accurate patient billing and efficient account collection.
2. Implement specific performance measurement criteria and distribute a “dashboard of key indicators” to the organization’s management team and to Finance.
3. Quickly and proactively responds to Revenue Cycle issues to promote maximized reimbursement.
4. In collaboration with the CFO, implements annual goals for Revenue Cycle performance consistent with national benchmarks. Empowers the Revenue Cycle team to meet and/or exceed goals consistently.
5. Thoroughly understands and utilizes the Epic reporting and operating capabilities. Identifies and implements methods to automate and streamline Revenue Cycle processes through use of the [PMS].
6. Directs the evaluation of patient accounts to identify and resolve billing and processing problems in a timely manner.
7. Directs the implementation and maintenance of a system for the collection of delinquent accounts ensuring third-party payers are contacted.
8. Oversees credit and collection policies administered by front and back-end personnel. Monitors and makes improvements as necessary.
9. Directs the solution/s for difficult payment and associated business office problems, including problematic account audits.
10. Coordinates the exchange of information with the Medical Records department and other departments to obtain and analyze additional patient information to document and process billing, respond to insurance inquiries and manage liability accounts.
11. Promotes effective communications between patient accounting systems personnel and front-end staff to ensure ongoing education, training and timely problem resolution.
12. Directs information systems training personnel assigned to front-end and back-end billing operations.
13. Directs the work process within the patient registrar and central billing office services. Develops work standards, monitors the quality and quantity of processed work, and ensures that policies were communicated and administered consistently. Works closely with site personnel and operations managers to monitor ongoing compliance to policies and procedures relating to the Revenue Cycle.
14. Oversees the functionality and integrity of the information system, whether an in-house system or on contract with a vendor. Works with information technology personnel to ensure timely and accurate administration of work processes within the system, including the submission of electronic claims to third party carriers, claims logistics development and maintenance, customized reporting, and electronic remittance of third party payments.
15. Oversees the evaluation of University of Maryland Community Medical Group’s fee schedule on an annual basis at minimum, which requires cross-referencing UMCMG’s fees with the top five payers and making appropriate adjustments.
16. Directs the management of all personnel within assigned business office duties. Trains, orients and evaluates the performance of assigned personnel. Decided on relevant merit increases, promotions and disciplinary actions. Works closely with operations managers to gain insight into the evaluations of front-end Revenue Cycle personnel within office sites.
17. Oversees the management of daily operating activity of central billing and makes necessary adjustments in work assignments to maintain optimal accounts receivable and customer relations.
18. Maintains a current knowledge of and ensured compliance with the relevant policies and procedures pertaining to patient confidentiality, patient rights, government, and insurance and third-party payer regulations.
19. Promotes exceptional customer service to patients and internal constituents through leadership and implementation of standards.
20. As a key member of the organization’s leadership team, actively participates in appropriate administrative and committee meetings.
21. Participates in the professional development activities and maintained professional affiliations within the area of expertise.
22. Coordinates, with the Director of Finance, an annual capital equipment budget for Revenue Cycle operations.
As a University of Maryland Community Medical Group (UM CMG) employee, you will enjoy a comprehensive benefits program designed with you and your dependents in mind. Subject to any eligibility waiting period, all of the benefits are available to regular full-time employees and most benefits are available to regular part-time employees who are regularly scheduled to work twenty (20) or more hours per week. Many benefits are provided at no cost to employees. For others, the cost is shared between UM CMG and employees.
1. Bachelor’s Degree in Business or Administrative Healthcare related field.
2. Seven (7) years of experience in Revenue Cycle operations with at least 3 years’ experience in a relevant leadership role is required.
3. Three (3) years’ experience managing patient registration, time of service collections and charge entry function in a multi-specialty setting is required.
4. Experience managing or directing Revenue Cycle operations through a system conversation is highly preferred.
Knowledge, Skills and Abilities
1. Extensive knowledge of third-party and insurance company operation procedures, regulations and billing requirements, and government reimbursement programs.2. Thorough understanding of medical information systems for billing and accounts receivable, spreadsheet analysis, reporting applications, medical terminology, and coding and office procedures.