Director of Revenue Cycle Management
20 days ago
West Palm Beach
Job Description About FCHC: Since 1976, Florida Community Health Centers, Inc. (FCHC) has been a health care leader in Florida. We provide comprehensive primary and specialty health care and patient support services through a network of Centers surrounding Lake Okeechobee and across Floridaâs Treasure Coast. Our mission is to ensure that everyone in our communities has access to culturally competent, high-quality health care that they can afford. FCHC has locations in Clewiston, Moore Haven, Okeechobee, Fort Pierce, Port St. Lucie, Stuart, Indiantown, Pahokee and West Palm Beach. FCHCâs Corporate Office is centrally located in West Palm Beach, Florida. FCHC has multiple staff members who speak Spanish and Creole, and translation is available for other languages as needed. FCHC has created a âone-stop shopâ for patientsâproviding Pediatric and Adult Primary Care, Dental, OB/GYN and Womenâs Health, Infectious Disease, Behavioral Health, Pharmacy, chronic disease education and care management, referral assistance, benefit enrollment assistance and coordination, and telehealth services. Our patients benefit from a âmedical homeâ model, where they may access our extensive array of health care clinicians and services in an atmosphere where they are treated with respect, care, and concern. Mission The Mission of Florida Community Health Centers, Inc. (FCHC) is to provide accessible, cost-effective, high-quality, comprehensive health care to all persons in our communities. Vision Florida Community Health Centers, Inc. (FCHC) will maintain strong leadership in, and advocate for, the provision of health care services. FCHC will foster and promote collaborative relationships and will develop partnerships with local, state, and federal public health service agencies and the community in general, to enhance the quality of delivery systems for comprehensive health care. FCHC will be an employer of choice and will demonstrate excellence with a highly trained staff and governing board. Values FCHC values Integrity, Compassion, Commitment to serving others (external and internal to the organization), Innovation, Effectiveness (cost and outcome), Efficiency, being Mission-driven, Commitment to serving others internal to organization and Commitment to Excellence. Position Summary: The Manager of Revenue Cycle Management is a high-impact, key member of the Florida Community Health Centers, Inc.(âFCHCâ) leadership team, responsible for overseeing all patient service and pharmacy revenue including coordinating and reporting on all aspects of payer billing & collections. The Billing Analysts and Medical Coder report into this position, with matrix reporting from the Senior Accountant (Revenue) and close collaboration with the Director of Finance (Controller). Works closely with Credentialing and HR department staM responsible for provider/clinician credentialing who maintain the Epic Provider Enrollment table as current. This position also collaborates with leaders across the organization in Clinical, Quality, Pharmacy, Operations, HR and Strategic Initiative areas Roles and Responsibilities: RCM Systems Oversight & Administration ⢠Monitor and report on the performance of Epic, Rx30 and other peripheral electronic medical record and billing systems., ⢠Design and communicate billing & Epic Professional Billing (âPBâ) ârulesâ to Health Choice Network (âHCNâ) on regularly scheduled and attended meetings., ⢠Regularly monitor volume of prescriptions transmitted to contract 340bThird Party Administrators (âTPAsâ), noting any significant changes in volume or margin (net recovery) from those transactions, ⢠Support FCHCâs CFO in reviewing the financial impact of all changes to the organizationâs charge master in Epic, Rx30 or peripheral systems., ⢠Work closely with Finance Dept leadership on ensuring EOB and payment posting activities reported in the central clearinghouse reconciles to FCHCâs general ledger (Great Plains Dynamics) and to ensure all RCM activities are recorded correctly and accurately., ⢠Advises the Manager of Payor Relations & Credentialing of all denials where reason codes state providers were not properly credentialed and/or providers do not have the appropriate taxonomy or place of service recorded in their claim systems, ⢠Maintain all changes to and coordinate updates to FCHCâs Billing & Collections and Sliding Fee Discount Program (âSFDPâ) Administration policies., ⢠Meet periodically with HCN Assoc. Director, Integration & Patient Experience and the Labcorp Business Development Executive, Value-Based Care to ensure reference laboratory activity and associated billing to FCHC is meeting stated performance and contract standards., ⢠Build and support Financial Estimate templates in Epic as a way to improve the accuracy of patient collections at the health centers., ⢠Support FCHCâs Director of Finance (Controller) and CFO in the process of administration over all HRSA-required policies that impact patient Billing, Collections, the SFDP compliance areas, ⢠Directly supervise team of Epic Billing Analysts, ⢠Oversee formal Epic âactionsâ taken by the Billing Analysts including but not limited to post-billing write-offs, appeals and escalations., ⢠Along with the Director of Operations, host weekly âDenials Managementâ calls with health center leadership to assist in their Epic workqueue efforts (specifically to increase the rate of âclean claimsâ generated), ⢠Develop âmicro-learningâ training sessions for target denials management areas, ⢠Collaborate with the Director of Finance (Controller) on the development of a monthly RCM variance analysis and other reporting to be included in senior leadership and Board-committee level reporting, ⢠Establish relationships with payer (claims) representatives, schedule and conduct regular meetings to review trends in denials, collections expectations, status of provider credentialing/linkages, and Epic payor scorecard results, ⢠Analyze contract variances by service line, make recommendations for changes to Epic billing rules, payer fee schedules in Epic, FCHC chargemaster rates, timing and method for payer rate negotiations, ⢠Collaborate with the Chief of Strategic Initiatives and Manager of Payor Relations & Credentialing on contract and fee trends prior to each payer meeting, ⢠Lead all eMorts tied to payer âescalationsâ (where payers will have to run claims impact reports prior to paying FCHC for previously denied claims), ⢠Monitor the performance of all âSpecial Contractsâ (non-payer agreements with community partners) including but not limited to analyzing net realization of associated services and administrative eMorts needed to support the contracted activities., ⢠Collaborate with the FCHCâs Regional Medical Directors and Medical Coder on the development of Epic coding ârulesâ (or smart lists, macros, other methods of automation) that will result in improved clinical documentation across all department specialties, ⢠Support FCHCâs Medical Coder in the process of addressing HCC coding work queues, identifying trends and potential clinical documentation barriers to optimizing patient risk scores, ⢠Draft and distribute weekly âRCM Briefingsâ which highlight key trends in RCM and Operations that impact patient service and pharmacy revenue, ⢠Draft and distribute monthly Epic âDenials Analysisâ report, highlighting significant trends in preventable denials and specifically identifying areas where focused efforts will improve net financial recovery, ⢠Collaborate with the Director of Finance (Controller) and other Finance Department leaders by performing detailed reviews of Accounts Receivable (âARâ) to ensure FCHC reserves are adequate yet not excessive, ⢠Draft and coordinate the performance of billing audit work programs, designed to address specific risks identified in FCHCâs reimbursement risk management domain, ⢠Support FCHCâs CFO and Director of Finance (Controller) in the development of semi-annual budgets and forecasts (patient service and pharmacy revenue projections) Minimum Requirements (experience, training, and education): To effectively fulfill this position, candidate must meet the following requirements: ⢠Minimum of five (5) yearsâ experience working in revenue cycle management, ideally in an Epic EMR environment, ⢠Bachelor of Science or Bachelor of Arts degree in applicable course work and applicable work experience. Masterâs level degree and some business law experience preferred., ⢠CPC certification and specific knowledge of Medicaid and Medicare billing or other regulatory guidelines applicable to federally-qualified-health centers preferred., ⢠Must demonstrate advanced knowledge of systems administration, best practices in RCM in ambulatory settings, payer credentialing, contracting, payer appeals and escalation activities