The Sr Director of Revenue Cycle is responsible for managing and supervising the central billing and collection operations, credentialing and contract management for service billing to ensure accurate and timely submission of claims, prompt collections and aggressive denial management. Effective and timely communication of department/program issues or success to practice managing partners and CFO. Ensures compliance with relevant laws, regulations, established company policies and compliance programs. Employee will share the vision and mission of PT Solutions.

ESSENTIAL FUNCTIONS:

• Responsible for maximizing the collection of medical services payments and reimbursements from patients, insurance carriers, financial aide, and guarantors
• Responsible for insurance eligibility processes, charge processing, claim submission and processing, payment processing, collections and accounts receivable management, denial management, reporting of results and analysis, concurrent and retrospective auditing, proper coding, credentialing, insurance contract review and oversight, customer services relative to revenue cycle, training and development relative to revenue cycle, analytics, and all other revenue cycle management activities.
• Responsible for management and negotiation of payer contracts to ensure PT Solutions is obtaining competitive rates for reimbursement of services provided.
• Responsible for credentialing of therapists with insurance plans to ensure reimbursement for services provided.
• Plans, organizes, directs and controls Patient Accounts billing to maximize collection of revenue and minimize bad debt, including monthly review of program aging, bad debt estimates, denial reports, etc.
• Makes use of management practices that include empowerment of staff, the provision of clear and concise expectations regarding duties assigned to employees, frequent feedback focusing on both positive and problematic aspects of work performance and other management practices that are consistent with Continuous Quality Improvement.
• Promotes and maintains harmonious and effective relationships and communications within the department and with other departments.
• Provides leadership support and technical oversight of billing and collection functions performed by staff.
• Management oversight of all revenue cycle functions related to the patient visit from point of entry to accurate adjudication of the patients’ accounts.
• Provide feedback to the operations team to drive improvements and reduce denials that impede collections activities.
• Specific areas of responsibility include Revenue Cycle Training, Credentialing Registration, Claims Management, Billing, Collections, Patient Insurance, Data Processing, Integrity of Patient Accounts, Accounts Receivable Management, practice management system file maintenance, payer contract management and third party revenue cycle vendors.
• Responsible for provider reimbursement programs, policies, and strategies to ensure unit cost controls meet or exceed corporate objectives for medical cost containment.
• Analyzes claims, utilization, and medical cost data.
• Develops strategic, cost effective programs, and makes system or network changes to enhance competitive position.
• Monitors aged accounts and verifies appropriate collections procedures are being followed.
• Manages revenue cycle projects at the Practice level, such as audits.
• Regularly provides upper management with revenue cycle status including reports, metrics, and presentations.
• Develops, monitors, and assesses business metrics in order to refine processes and improve efficiencies
• Establishes internal goals and identifies external benchmarks.
• Resolves escalated reimbursement issues with Payor’s Practice, for optimal management of accounts receivables.
• Acts as a catalyst of change and stimulates others to change.
• Manages implementation effectively.

Organizing and Implementation

• Establishes Patient Accounts department billing work flow and procedures and best practices for revenue growth.
• Ensure revenue, payer contractual allowances and accounts receivable information is appropriately reported at month end.
• Works with the CFO to implement and maintain Patient Accounts Department policies and procedures to assure appropriate submission and payment of claims.
• Develops and implements progressive short-term goals that align with the company’s vision and business goals.

Controller

• Manages the Accounts Receivable staff within allocated budgetary parameters.
• Responsible for ensuring monthly revenue meetings with staff are held to ensure accurate revenue and billable services.
• Monitors month end reconciliation performed by staff for accuracy and addresses variances accordingly.
• Reviews month end reconciliation reports for accuracy and balancing.

Customer and Community Relations

• Actively participates in meeting customer needs and adapting to changing customer needs at all times.
• Participates and encourages participation from staff in activities, including professional and trade organizations that promote mental health services and/or their current job responsibilities.

Compliance/Quality Improvement

• Establishes and defines production standards to ensure that optimal performance measurements are keeping pace with technology.
• Assesses the quality of work rendered by the Patient Accounts staff to ensure sound procedures are followed.

Professional Development

• Assumes responsibility for her/his professional growth and the ongoing professional development of the Patient Accounts billing staff.
• Duties and responsibilities may be added, deleted and/or changed at the discretion of CFO.

REQUIRED SKILLS and ABILITIES:

• Excellent supervisory skills including proven ability in coaching, performance improvement and disciplinary action.
• Understanding of basic accounting principles.
• Detailed knowledge of Medicare, Medicaid, commercial insurance billing and other payers along with associated billing/collections timelines.
• Strong analytical and problem solving skills with the ability to move issues forward to resolution.
• Ability to understand complex reimbursement contracts.
• Ability to work and communicate effectively with program staff, management staff, government representatives and customers.
• Computer literacy and demonstrated capacity to work with sophisticated automated billing systems as well as manual systems.

REQUIRED CREDENTIALS:

• Strong organizational skills and an ability to prioritize deadlines
• Work collaboratively with cross-functional teams
• Excellent customer service

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Expanding Access to Quality Care

At PT Solutions, we’re more than colleagues; we’re a tight-knit community united in our mission to expand access to quality care. Our commitment to you is evident in our industry-leading professional development opportunities. From ongoing evidence-based clinical education to dedicated mentorship opportunities and an APTA-accredited Orthopaedic Residency Program, we propel our clinicians toward excellence in physical therapy, occupational therapy, speech-language pathology, and athletic training.

As we aim to be the go-to rehabilitation provider, we seek committed professionals eager to join us in that mission. A career with PT Solutions is an opportunity to shape the industry and make a lasting impact. 

Let’s go further together and transform care. Join the #PTSLife today! 

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