Experience & Skills

·         7–10 years of hospital revenue cycle experience.

·         3–5 years in a management role.

·         Direct experience in a Critical Access Hospital or small rural hospital.

·         Expertise in Medicare cost-based reimbursement, cost reports, denials reduction, and A/R management.

·         Experience leading outsourced billing and coding vendors while collaborating closely with clinical departments, finance, compliance, and executive leadership.

·         Supervising business office staff

·         Developing department policies and procedures

·         Budget management

·         Staff training and coaching

·         Working with physicians and clinical leadership

·         Presenting financial metrics to executive leadership and the governing board

• Familiar with Microsoft suite of applications – Excel, Word, Teams, Outlook

• Patient registration and insurance verification
• Charge capture and Charge Description Master (CDM) oversight
• Insurance credentialing for facility and providers
• Coding and clinical documentation improvement (working knowledge)
  • Claims submission and electronic billing – inpatient, outpatient, emergency, rural health clinic, observation

·         Ability to interpret and apply federal, state and commercial payer regulations

• CPSI/TruBridge and EMDs

IV.          ESSENTIAL JOB FUNCTIONS:

Revenue Cycle Oversight / Leadership and Collaboration

Direct and oversee all phases of the hospital’s revenue cycle, including patient registration, charge capture, coding, billing, claims submission, accounts receivable management, payment posting, and collections.

Develop, implement, and monitor revenue cycle policies, procedures, and performance metrics to ensure compliance, efficiency, and accuracy.

Analyze revenue cycle processes to identify opportunities for improvement and lead initiatives to optimize reimbursement and reduce denials.

Collaborate with clinical departments, finance, and administration to ensure accurate documentation and charge capture.

Lead, mentor, and develop the HIM and billing teams, fostering a culture of accuracy, accountability, and continuous improvement.

Serve as a liaison between clinical, financial, and administrative departments to ensure cohesive revenue cycle operations.

Provide regular reports and performance updates to leadership on key revenue cycle indicators and financial outcomes.

• Days in Accounts Receivable (A/R)
• Net Collection Rate
• Clean Claim Rate
• Denial Rate
• Bad Debt Percentage
• Cash Collections
• Aging Accounts Receivable

Health Information Management (HIM)

Work collaboratively with the HIM Lead in supervision of HIM staff responsible for medical records management, chart completion, release of information, transcription, and coding functions. 

Ensure compliance with HIPAA, CMS, and state regulations governing health information privacy, documentation, and record retention.

Oversee the integrity, security, and accessibility of electronic health records (EHR) and patient information systems.

Manage clinical documentation improvement (CDI) efforts and ensure accurate coding to support compliant and optimal billing.

Stay current with regulatory changes affecting HIM and billing practices, particularly those impacting CAH reimbursement models.

Billing and Collections

Vendor Management and Oversight

Serve as the primary organizational contact for the outsourced billing and revenue cycle partner.

Establish and monitor performance expectations and service level agreements (SLAs).

Conduct regular operational and performance review meetings with the billing vendor.

Ensure timely resolution of billing, coding, claim submission, denial management, and payment posting issues.

Evaluate vendor performance against established benchmarks and contractual requirements.

Escalate and resolve revenue cycle issues affecting reimbursement, patient satisfaction, or compliance.

Revenue Cycle Performance

Monitor and analyze key revenue cycle metrics including:

Identify trends and opportunities for process improvement.

Develop and implement corrective action plans to improve financial performance.

Collaborate with finance leadership on revenue forecasting and cash flow projections.

Monitor patient billing and collection processes performed by the vendor.

Ensure a positive patient financial experience through accurate billing and responsive customer service.

Review financial assistance, charity care, and collection agency activities for compliance with organizational policies

Denial Management and Reimbursement Optimization

Review denial trends and root causes.

Work with the billing vendor and internal departments to reduce claim denials and payment delays.

Ensure appeals are filed timely and effectively.

Monitor payer reimbursement patterns and contractual compliance.

Recommend operational improvements to maximize reimbursement and reduce revenue leakage.