Director, Revenue Cycle Mangement

Director, Revenue Cycle Management wanted for rapidly growing company in So. Plainfield!

Purpose of the Position:
Responsible for management and support of enterprise-wide revenue cycle for billing and reimbursement. Compliance officer responsible for ensuring full Federal and State Compliance.

Responsibilities:

• Directs and oversees the overall policies, objectives, and initiatives of the organization’s revenue cycle activities to optimize reimbursement and ensure compliance
• Works with upper management/leadership team regularly to discuss plans of action, issues,best practices, and compliance
• Assesses and makes recommendations to improve efficiency of current systems/processes for the entire Revenue Cycle
• Be the main contact point as it pertains to any revenue cycle management questions, concerns,updates.
• Prepare monthly revenue cycle reports
• Manages the internal billing staff
• Reviews, designs, and implements processes surrounding billing, pricing, third party pay relations, compliance, collections and other financial analyses to ensure that revenue cycle is effective and properly utilized
• Identify and analyze reimbursement trends to advise Upper Management and internal stakeholders accordingly
• Perform prospective and retrospective chart audits, reviewing for accuracy and compliance
• Work closely with billing vendor and reimbursement staff to address billing issues and streamline workflows
• Work closely with Internal and External Sales Groups to ensure proper guidelines are followed and ensure any questions or concerns as they relate to billing and reimbursement are handled in a timely and efficient manner
• Investigate billing issues due to potentially inappropriate documentation, coding, and/or medical necessity
• Follow up with the referring physician offices and/or Internal/External Sales Groups to ensure corrective actions are taken
• Investigate, evaluate, recommend, and implement coding and fee updates
• Negotiate contracts with payers based on needs of the company
• Perform other administrative and supervisory duties as assigned

Qualifications:

• Bachelor’s Degree or relevant experience required
• Coding certification required
• 10+ years’ experience Staff Management
• 10+ years’ experience hands on billing & coding required
• Strong understanding of the Revenue Cycle and ability to manage each aspect of it
• Compliance Officer experience a plus
• Experience in a molecular / genomics lab highly preferred
• Audit Certificate highly preferred
• Strong understanding of the Medical/Laboratory Billing Process and Industry Standard
• Exceptional Knowledge of ICD’s, CPT’s, and LCD’s.
• Must possess strong knowledge of EOB’s and ERA’s with the ability to read and understand the follow-up steps required to mitigate any issues that need attention
• Successful track record of negotiating with insurance companies to be brought in-network
• Highly proficient in Microsoft Office, specifically Excel
• Excellent interpersonal, verbal, and written communication skills
• Ability to multitask and manage several projects concurrently
• Ability to think outside the box

Excellent benefits package!  
Salary $100-$150k