The Revenue Cycle Director leads Planned Parenthood Columbia Willamette’s (PPCW) revenue cycle operations by providing operational leadership, oversight, evaluation, analysis, and direction to enable sustainable growth and optimization of PPCW’s client base, revenue, and market share in a manner consistent with overall organizational mission, goals, and objectives and in compliance with state and federal laws and regulations.
The Revenue Cycle Director leads PPCW revenue cycle staff members and acts as the primary liaison between the third-party billing vendor and PPCW. The Revenue Cycle Director coordinates with Patient Services management and staff members to optimize the revenue cycle-related functions conducted in the Health Centers and / or Call Centers.
The Revenue Cycle Director identifies and evaluates opportunities for new revenue sources and lost revenue through analysis of revenue cycle metrics, strategic partnerships, and business development. The Revenue Cycle Director identifies, develops, and implements performance metrics and provides ongoing analysis and tracking to Executive, Finance, and Patient Services management.
Review, revise, and/or implement policies and procedures for all revenue cycle processes, collaborating with Patient Services and PPCW’s third-party billing vendor as appropriate, to ensure that PPCW is maximizing billing and collections, while remaining in compliance with federal, state, and HIPAA privacy and security laws and regulations; the terms of PPCW payer contracts; and in alignment with Planned Parenthood’s mission. This includes pricing, coding, eligibility and prior authorization checks, charge entry, claim submission, payment posting, denials management, bad debt & collections, appeals processing, credit balance resolution, and accounts receivable management.
Act as key liaison between third-party billing vendor and PPCW; ensure that the vendor provides required detailed data as well as synthesizes it into key messages via executive dashboards and reports.
Oversee the work of the third-party billing vendor, including audits of their work and regular review of their processes to ensure accuracy and compliance with their contract and applicable state and federal laws and regulations.
Work closely with Patient Services management and staff members and the training department to train staff, as well as define and implement procedures on front-end processes such as data collection, point of service patient collections, and insurance verification; create tools that can be used by staff to support efficient revenue cycle processes.
In conjunction with the Vice President of Finance, evaluate and implement technological tools to improve efficiency and productivity in the management of fee schedules, payer contracts, and accounts receivable.
Develop and report on benchmarks and key indicators of revenue cycle functions to be reported on various timeframes including daily, weekly, and monthly basis and to various audiences including the Board, senior management and PPCW staff members; ensure metrics are continuously measured, monitored and improved; identify solutions for improving results for benchmarks not meeting established goals.
Analyze data requirements of billing and finance staff and senior management, and create and produce a range of reports to address these needs, including rejection reports, error reports, accounts receivable reports, revenue forecasts, and ad hoc reports.
Interact on an ongoing basis with PPCW’s payers to ensure maximum and accurate reimbursement and to address problems that may arise.
Analyze reimbursements from all sources, including carrier reimbursement exception reporting and follow up, pending claims analysis, and denials management.
In partnership with Human Resources Department and PPCW’s third-party billing vendor, provide periodic oversight to ensure PPCW’s healthcare practitioners are properly credentialed in a timely manner.
Analyze accounts receivable data (such as days outstanding in accounts receivable, percent of accounts over 90 days old, bad debt percentages, etc.), extract it into meaningful presentations, and communicate the results, as well as identify problem sources and develop an action plan for continuous improvement.
Collaborate with Patient Services in the planning, implementation, administration and evaluation of PPCW’s service processes to maximize cost-effectiveness, revenue, and customer service; take initiative to collaborate with other Planned Parenthood affiliates in projects that have the potential to generate revenue, improve services, or reduce costs.
Participate in the development of the Patient Services department long range and annual work plans / budgets related to revenue cycle processes; work with senior management, regional directors, health center managers and lead clinicians in support of implementation of annual and strategic plans.
Provide support of Title X program grants and reports; ensure tasks related to Title X productivity and financials are aligned with affiliate’s strategic mission.
Bachelor’s degree in accounting, finance or related field; or equivalent combination of education and experience.
Five (5) years revenue cycle management experience.
Three (3) years of supervision experience including hiring, training and evaluation.
Thorough understanding of third-party payer contracts, Medicaid reimbursement, provider enrollment and compliance.
Excellent understanding of medical practice management, with thorough knowledge of CPT and ICD-10 billing codes.
Strong knowledge of Oregon & Washington Medicaid programs and regulations.
Internal Number: 1
About Planned Parenthood Columbia Willamette
Planned Parenthood Columbia Willamette (PPCW) is committed to providing, promoting, and protecting access to sexual and reproductive health care in Oregon and Southwest Washington. Since 1963, PPCW has provided a broad range of sexual and reproductive health care, including family planning, preventative care, and other medical services; trained and educated community members on issues of sexuality; and advocated for the protection of reproductive rights and freedom in Oregon and Southwest Washington. Each year, more than 58,000 women, men and teens visit a PPCW health center, located in NE and SE Portland, Milwaukie, Beaverton, Salem, and Bend, Oregon; and Vancouver, Washington.