Planned Parenthood of Greater New York
Associate Director of Revenue Cycle Optimization
Full-Time
$135k - $165k/yr
Senior
Bachelor's, Associate's
New York, NY, USA
Hybrid
About the job
Requirements
- Proficiency with Microsoft Office Suite, including advanced Microsoft Excel skills such as PivotTables and VLOOKUPs.
- Deep understanding of electronic medical record systems and experience working in an Epic environment.
- Strong data management and data analysis skills, including the ability to critically analyze large data sets.
- In-depth knowledge of Medicare and Medicaid regulations, including billing, coding, and documentation requirements.
- Strong experience in revenue cycle management and optimization.
- Experience with process improvement principles.
- Excellent interpersonal, written, and verbal communication skills.
- Ability to develop and maintain effective professional relationships with internal and external stakeholders.
- Excellent organizational skills and the ability to produce high-quality work in a fast-paced environment with changing or competing priorities.
- Ability to exercise sound judgment, make independent decisions, handle confidential information discreetly, and produce reliable work with minimal direct supervision.
- Minimum of an associate degree in business administration, accounting, healthcare administration, or another related field.
- Minimum of five years of experience related to billing, coding, denial management, and underpayment analysis.
- Demonstrated leadership skills.
- Two years of experience with Epic reporting, including SlicerDicer or Clarity.
- Proof of immunization or immunity to specified communicable diseases and tuberculosis testing.
- Ability to perform prolonged sitting and repetitive computer tasks, periodically stand, walk, and bend, and lift or move up to 15 pounds.
Responsibilities
- Support the Vice President of Revenue Cycle Operations and Optimization in managing third-party billing and Epic hosting organizations.
- Identify and implement revenue optimization strategies and ensure regulatory compliance with third-party insurers.
- Maintain billing and reporting systems and support fee schedule, contract, and credentialing activities for managed care contracts.
- Lead strategic revenue cycle optimization initiatives that improve financial performance, operational efficiency, and regulatory compliance.
- Manage third-party revenue cycle management vendors and Epic managed services partners to optimize revenue, improve reimbursement, reduce denials, and enhance billing operations.
- Collaborate with clinical, operational, finance, information technology, and payer stakeholders to strengthen revenue integrity, reporting, reimbursement accuracy, and overall revenue cycle performance.
- Recruit, retain, and develop staff; provide performance feedback; maintain a safe and professional work environment; and complete performance evaluations, goal setting, and corrective action processes.
- Partner with Human Resources and Revenue Cycle leadership on recruitment, onboarding, succession planning, employee engagement, and staff retention initiatives.
- Provide leadership, training, mentoring, and operational support, and promote accountability, continuous improvement, operational excellence, and collaboration.
- Analyze revenue cycle trends to identify opportunities to prevent denials, optimize reimbursement, improve first-pass claim acceptance, and maximize cash collections.
- Perform root cause analysis of revenue cycle issues, develop corrective action plans, and implement process improvements.
- Develop, execute, and manage work plans through completion, including billing corrections, reimbursement optimization, appeals, and workflow improvements.
- Partner with the Epic managed services organization and Information Technology to implement automation and system enhancements.
- Collaborate with the third-party revenue cycle management vendor to implement process changes.
- Collaborate with cross-functional teams to align clinical operations, revenue cycle workflows, payer requirements, and billing practices.
- Track adherence to process changes, measure key performance indicators, and quantify financial outcomes.
- Monitor and report revenue cycle performance indicators, including cash collections, days in accounts receivable, denial rates, clean claim rates, charge lag, timely filing, and underpayment recovery.
- Monitor health centers' adherence to charge reconciliation processes and key performance indicators, and partner with health center leadership to address trends and improve revenue performance.
- Ensure changes to the charge description master are implemented within clinical systems.
- Review changes in Current Procedural Terminology, Healthcare Common Procedure Coding System, and revenue codes for accuracy, compliance, and reimbursement optimization.
- Identify opportunities to automate manual revenue cycle processes through Epic optimization, workflow redesign, reporting enhancements, and collaboration with Information Technology and vendor partners.
- Guide the Senior Data Analyst in developing and implementing reporting tools to identify revenue cycle trends and denial root causes.
- Supervise the building of reporting tools and periodically build reports directly to monitor staff and vendor productivity and quality affecting revenue cycle results.
- Work with the Data Analytics team to develop dashboards, scorecards, and other performance-monitoring tools.
- Develop and deliver training, or partner with appropriate departments to provide education, on revenue cycle processes, system enhancements, regulatory requirements, and operational best practices.
- Maintain current knowledge of Centers for Medicare & Medicaid Services billing rules and payer requirements.
- Remain current on Epic reporting tools.
Desired Qualifications
- A bachelor's degree.
- Epic-related certifications and reporting experience.
- Coding certification such as Certified Coding Specialist, Registered Health Information Administrator, or Registered Health Information Technician, or applicable experience.