Director of MSO Revenue Integrity

The Director, MSO Revenue Integrity ("Director") is responsible for the direction and leadership of operational, financial, programmatic and personnel activities for revenue cycle management functions associated with CCNC MSO Services ("MSO Services") which includes medical practice billing/collection and relevant support for CCNC Medicare programs. For medical practice billing/collection, the Director shall oversee and manage provider enrollment, claims submission, accounts receivable, payment posting, insurance reimbursement, claim denials, and patient collections as well as developing and monitoring department workflows and providing education and training to staff related to medical practice revenue cycle management. For supporting CCNC Medicare programs, the Director will oversee the daily activities of the teams involved in supporting practices in the billing of contracted services such as Chronic Care Management (CCM) and Advanced Primary Care Management (APCM), including practice invoicing and patient insurance verification, while ensuring the proper delivery of outstanding patient and practice experience.

The Director is also responsible for developing and maintaining relationships with MSO clients and partner CCPN practices that are participating in the developed CCNC Medicare program(s). This includes providing operational and financial transparency to the clients and partner practices in conjunction with various other CCNC team members.

The Director reports directly to the CCNC Chief Financial Officer and will also support related enterprise-wide projects and initiatives that relate to CCNC and CCPN priorities, systems redesign, revenue improvement, increased productivity/efficiency and/or reduction of costs.

Essential Functions

Operations

• Manage daily operating functions of revenue cycle process and billing staff for MSO Revenue Integrity department
• Oversee development, implementation, and monitoring of revenue cycle management policies, protocols, and workflows to meet department KPIs, goals and initiatives
• Identify denial/billing error trends through management of Days in AR and other billing metrics and communicates these to CFO, staff, MSO clients and contracted practices
• Take action towards continuous improvement and innovative use of technology and billing software to enhance automation, productivity and effectiveness of revenue cycle management processes
• Demonstrate achievable and measurable results and develop action plans for improvement
• Remain knowledgeable and proficient in all MSO Revenue Integrity department job functions and active in monitoring and auditing staff's work

• Develop relationships and partner with MSO Clients and contracted practices to ensure maximum revenue cycle operational effectiveness
• Produce accurate monthly revenue cycle reporting and meet deadlines for month end close and reporting
• Verify that MSO clients and contracted practices meet all requirements for billing of contacted services
• Manage payer credentialing process for providers and staff organizations contracted for such MSO Services
• Adhere to CCNC privacy and security policies to ensure that patient and company data are properly safeguarded.
• Abide by department guidelines, company policies, and HIPAA regulations.
• Attend departmental and corporate meetings, local and regional trainings, or other events as required
• Understand and uphold CCNC goals, objectives, and standards
• Perform other duties as assigned that assist in keeping the operation organized and functional

Quality Improvement

• Collaborate with the CFO and other members of the leadership team to assure that relevant policies/procedures, protocols, and goals of the MSO Revenue Integrity department are in compliance with CCNC and/or other Medicare and contractual regulatory requirements for continuous Quality Improvement initiatives
• Implement and manage processes to ensure compliance to established guidelines, protocols and procedures
• Communicate effective strategies for improving revenue cycle process to CCNC leadership, staff, MSO clients and contracted practices on a regular basis
• Oversee prospective audits in accordance with the organization's Corporate Compliance Policy

Staff Management

• Collaborate with other leaders and oversee the development, training, and onboarding of new staff, and the ongoing development and implementation of training plans for all existing MSO Revenue Integrity department team members on new and existing programs, policies, protocols, and workflows, including tools and content, to meet regulatory and/or contractual obligations
• Provide effective leadership in staff management with respect to recruitment, selection, retention, training, evaluation, compensation, continued professional and educational development, and communication
• Assure staff are well trained in and maintain compliance with all organization and department goals, policies, procedures, and business processes.
• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
• Create an environment that encourages diverse opinion, recognizes differences and incorporates into process and services
• Assure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
• Complete performance evaluations on direct reports and set goals for performance and deadlines in line with organization goals and vision
• Collaborate with Finance and HR and other business partners to develop and monitor strategies for allocating resources to meet program goals and outcomes and to control cost through effective use of personnel
• Utilize conflict resolution and problem-solving skills to manage issues in a timely manner
• Mentor and coach staff to facilitate growth for performance improvement

Qualifications

• Bachelor's degree in related field; Master's degree preferred
• Minimum of ten (10) years of medical billing and revenue cycle experience
• Eight (8) years of progressively responsible management experience in a health care business setting and at least five years in a related leadership role
• Knowledge of professional fee billing, reimbursement and third-party payer regulation and medical terminology is required; Knowledge of general accounting principles preferred
• Broad knowledge of modern health care administration practices and principles within a Medicare, Medicaid and managed care environment and physician medical practice setting.
• Working knowledge of regulatory requirements pertaining to health care operations and their impact on operational performance

Knowledge, Skills, and Abilities

• Excellent communication and interpersonal skills to include the ability to negotiate and resolve conflicts and build teams
• Skilled in establishing rapport with CCNC team members, MSO Clients and contracted practices either in person or via virtual means
• Demonstrated creativity, flexibility and innovative approach to problem resolution
• Excellent coaching, team building and supervisory skills
• Ability to work collaboratively across CCNC departments, MSO clients and contracted practices
• Effective analytical ability in order to develop and analyze options, recommend solutions to and solve complex problems and issues
• Effective organizational, planning and project management abilities
• Experience in financial and programmatic presentations
• Ability to work independently and function as an integral part of the team
• Ability to recognize personal strengths and weaknesses and develop goals for professional growth and achievement
• Knowledge of and compliance with federal and state regulations applicable to the position
• Computer skills required including various office software and the internet; experience with MS Office software preferred
• Motivational Interviewing skills and knowledge of adult learning and teaching principles
• Sensitivity to diversity of cultures, language barriers, health literacy and educational levels
• Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives
• Able to shift strategy or approach in response to the demands of a situation

Working Conditions

• Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time
• Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices
• Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds
• Willingness to occasionally travel within the applicable CCNC region/state