Director of Revenue Cycle Full Time Burien, WA.
hace 2 días
Seattle
Job Description Northwest Kidney Centers seeks a Director of Revenue Cycle. To lead patient billing and finance. The position is a full-time, hybrid position based at Burien, WA. Shift: Full-time, Monday-Friday, Hybrid. GENERAL SUMMARY The Revenue Cycle Director (RCD) reports to the Vice President of Finance/CFO and leads the patient billing and patient finance teams. The RCD oversees the revenue cycle process and ensures accurate and timely billing of patient services (In-clinic dialysis, Home Program dialysis, and Acutes) within the time constraints of the monthly accounting closing schedule. Includes oversight of patient intake, authorization, billing, cash posting and collection functions, the design of a revenue control environment and develops new and improved revenue processes and policies. The RCD also ensures appropriate use and maintenance of the revenue cycle applications and interfaces with IT and application vendors for training and maintenance of these systems. This position is responsible for ensuring that patient billing and processing of payment receipts are consistently completed in a timely fashion and in accordance with policy and regulations. The RCD will minimize bad debt, improve cash flow, and effectively manage accounts receivables, including timely appeals of denied or short paid accounts. The RCD will work closely with the Director of Payer Contracts to ensure contracts can be operationalized by the Billing staff and that contract performance is met. As needed, the RCD will communicate with Payers and/or Legal to ensure full expected reimbursement is received. Additional responsibilities include coordinating day-to-day activities with other NKC personnel; liaison with patients and insurances, Medicare/Medicaid, and other organizations; and performance of all billing and collection duties and responsibilities. DUTIES AND RESPONSIBILITIES Revenue Cycle Operations & Performance • Own end-to-end revenue cycle performance: patient registration and insurance verification, eligibility, authorization, charge capture, coding, claim submission, payment posting, denial management, AR follow-up, patient collections, refunds, and bad debt., • Establish and manage KPIs including net collection rate, days in AR, aged AR >90/>120, clean claim rate, first-pass yield, denial rate by root cause, cost to collect, and unbilled/DNFB., • Drive month-end close deliverables in partnership with Accounting: revenue recognition support, AR valuation and reserve analysis, contractual allowance modeling, and cash forecasting inputs., • Lead root-cause analysis on denials and underpayments; build durable process and system fixes rather than recurring manual workarounds., • Partner with clinical operations, admissions, social work, and the insurance/patient advocacy function to resolve front-end issues that drive back-end rework. Dialysis & ESRD-Specific Payer Expertise • Manage billing across Medicare (ESRD PPS), Medicare Advantage, Medicaid and Medicaid managed care, commercial, and self-pay populations., • Oversee ESRD-specific requirements: CMS-2728/2746 workflows, Medicare entitlement and the 30-month coordination period, Medicare Secondary Payer and COB, in-center hemodialysis, home hemodialysis and peritoneal dialysis billing, AKI patients, separately billable drugs and HCPCS/J-code capture, condition and modifier usage, and monthly billing cycle integrity., • Monitor CMS rulemaking (ESRD PPS proposed and final rules, TPNIES/TDAPA, quality incentive program) and translate reimbursement changes into revenue, system, and workflow impacts., • Support payer contract analysis, rate modeling, underpayment recovery, and contract loading/verification in the billing system., • Maintain compliance with HIPAA, payer requirements, state regulation, charity care obligations, and internal controls. Billing System Ownership, Upgrades & Migrations • Serve as the organization's functional and technical owner of the billing/practice management system and clearinghouse environment., • Lead system version upgrades, patches, and full platform migrations: requirements definition, vendor management, data mapping and conversion, test scripting, parallel testing, cutover planning, go-live support, and post-implementation stabilization., • Own master file and configuration integrity: charge master, fee schedules, contract terms, payer plan mapping, edits and scrubber rules, revenue codes, HCPCS/CPT mapping, and workflow queues., • Manage EDI infrastructure — 837I claims, 835 remittance, 270/271 eligibility, 276/277 status — including enrollment, error resolution, and clearinghouse performance., • Coordinate integrations between the clinical/EMR system, billing system, general ledger, and reporting layer; own reconciliation between systems., • Partner with IT and vendors on security, access control, user provisioning, and change management protocols. Billing Ledger Reporting & Data Management • Design, build, and maintain detail-level billing ledger reporting: transaction-level charge, payment, adjustment, and AR reporting that ties cleanly to the general ledger and supports audit., • Build and maintain the standard reporting suite — AR aging, denial analytics, payer scorecards, cash forecasting, unbilled/DNFB, productivity, and revenue bridge reporting., • Write and maintain queries and extracts against billing system data; document data definitions and maintain a source-of-truth data dictionary for revenue cycle metrics., • Develop dashboards for the CFO, executive team, and operational leaders; deliver analysis with a clear narrative., • Ensure reconciliation discipline between billing system, bank/lockbox, clearinghouse, and GL. Automation & Continuous Improvement • Support automation across revenue cycle workflows — eligibility checking, prior authorization, coding support, claim status follow-up, denial triage and appeal drafting, payment posting exceptions, patient communication, and reporting., • Own the operating model for deployed automation: prompt and workflow design, tool/system access, guardrails, human-in-the-loop review points, escalation paths, and version control., • Establish governance and monitoring: accuracy and exception rates, audit trails, PHI handling and HIPAA compliance, vendor/BAA diligence, model or vendor change management, and documented fallback procedures., • Review and design processes before automation., • Strong systems skills and demonstrated expertise. Able to provide strong analytics on RCM operational KPI’s and drive systematic improvements. Leadership & Team Development • Lead, coach, and develop the revenue cycle team; set clear performance standards, quality review processes, and productivity expectations., • Build training and cross-training programs, including upskilling staff to work alongside automation and AI tools., • Manage staffing models, workflow assignment, and any outsourced/vendor partners., • Partner across Finance, Clinical Operations, Compliance, IT, and HR as a collaborative, mission-aligned leader., • Represent revenue cycle results and initiatives to the executive team, audit/finance committee, and external auditors. JOB CONDITIONS Must be able to communicate effectively in English over the telephone, in writing, and in person. Duties and responsibilities are performed in an office environment and hybrid setting. Physical activities require the ability to stand, walk, stoop, kneel, crouch, reach, lift, fingering, grasping, talking, hearing, and repetitive motions of hands, wrists, and fingers. Must have strong visual acuity to read, inspect information on monitors, inspect technical documents, and to work extensively with data on a PC. Physical requirements include the ability to lift/move objects weighing up to twenty pounds occasionally, and up to ten pounds frequently. The individual in this position operates the phone, computer, copier, and other office equipment as required. Demonstrated skills in Microsoft Office Products and knowledge of clinical software programs are required. CUSTOMER SERVICE STANDARDS Staff are responsible for demonstrating good customer service and professionalism. • CONSIDERATION: Greet customers promptly; show courtesy; recognize customer’s needs; respect privacy., • CONCERN: Listen to customers; express appreciation, be non-judgmental; take responsibility., • CONFIDENCE: Show a positive attitude; take personal initiative; inform; educate and reassure; provide prompt follow-up., • CONDUCT: Hold appropriate conversations; maintain a professional appearance; establish teamwork; show professional competency. EDUCATION AND EXPERIENCE • Bachelor’s degree in business, Finance, Accounting, Health Administration, Health Information Management, or a related field; equivalent experience will be considered., • Certification such as CRCR, CHFP, CPC, CPB, COC, RHIA/RHIT, or comparable preferred., • 7+ years of progressive healthcare revenue cycle experience, including 3+ years leading teams. preferred not-for-profit experience., • Demonstrated ownership of end-to-end revenue cycle with accountability for measurable KPI improvement., • Direct, hands-on experience administering a healthcare billing/practice management system — configuration and master file ownership, not just end-user proficiency., • Documented experience leading at least one billing system upgrade or platform migration/conversion., • Advanced Excel: pivot tables and pivot table design, Power Query, Power Pivot, complex formulas, model design, and large-dataset management., • Strong reporting and data skills: ability to independently build detail-level billing ledger reports and reconcile them to the general ledger., • Working knowledge of governmental and commercial payer rules, EDI transaction sets, and denial management methodology. Excellent written and verbal communication; able to explain technical detail to non-technical executives and clinicians. Learn more about us, NKC on YouTube Benefit offerings for eligible employees (.6-1.0 FTE): • Choice of 3 medical insurance plans: Premera Blue Cross (HDHP, Low Option PPO, High Option PPO), • Delta Dental & Vision Services Plan, • 401 Retirement Plan, Employer Match dollar for dollar up to 4% of your wages and an additional 1% Discretionary Match, • Disability benefits: Short-term & Long-term Plans, • Life & AD&D Plans, • Tuition Reimbursement of up to $4,000 annually, • Employee Assistance Program, • Employee Scholarship Program, • Flexible Spending & Health Savings Accounts, • 100% employer subsidized Commute/Transit Benefits available, • Paid Time Off (PTO) includes personal time off and holidays. Employees may earn up to 192 hours of PTO in their first year., • Paid Sick Time (PST) - Employees will earn 1 hour for every 30 eligible hours of work. Founded in 1962 as the world’s first outpatient dialysis provider, Northwest Kidney Centers operates 19 dialysis clinics across the Puget Sound region in addition to hospital-based services and a large home-based dialysis program. We are a not-for-profit, community-based organization and consistently rank among the top dialysis providers in the United States in quality of care, patient outcomes and transplant rates. At Northwest Kidney Centers, teamwork, integrity, respect, excellence and stewardship guide our approach to how we work. We differentiate ourselves by our patient centered approach and active commitment to advancing kidney research and dialysis innovation. Key to our success is the compassion and expertise of our dedicated team of staff that care for those we serve. Equal Employment Opportunity Northwest Kidney Center is an equal employment opportunity employer. Every employee has the right to work in surroundings that are free from all forms of unlawful discrimination. NKC will not engage in or tolerate any discrimination in the workplace prohibited by local, state, or federal law. Specifically, no employee will be discriminated against on the basis of their race (including physical characteristics historically associated with race, such as hairstyle or hair type), sex/gender, religion/creed, pregnancy, age, physical or mental disability, marital status, national origin, citizenship, immigration status, genetics/genetic markers, military or veteran status, sexual orientation, including gender expression or identity, actual or perceived victims of domestic violence, sexual assault, or stalking, or any other characteristic protected by applicable federal, state or local law. Preboarding Requirements: At Northwest Kidney Centers, we are committed to maintaining a safe work environment for all employees and patients. As part of our hiring process, we conduct pre-employment background checks, drug screenings (we do not test for THC), employment verification and references, which are contingent to be hired on with NKC. These checks ensure we are in compliance with regulatory requirements and uphold our standards of safety, excellence, stewardship, and integrity. We value transparency and respect your privacy; any information obtained during these screenings will be handled with the utmost confidentiality. Should you have any questions regarding this process, please feel free to reach out to our People Team. Please note: To protect our vulnerable patient population and our workforce, NKC strongly encourages all staff to receive the COVID-19 vaccine.
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