Sanitas Medical Center

ABOUT SANITAS:

Sanitas is a global healthcare organization expanding across United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for our patients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of our patients and their families creating a memorable experience through compassion, respect, and kindness.

THE POSITION:

This position is responsible for directing and leading all revenue capture, optimization and billing functions across all service lines and markets in the United States. Reporting to the CFO, the Revenue Cycle Director will take a “hands on approach” in contributing significantly to the concept, design, and implementation of the organization’s reimbursement function(s) to accommodate the company’s rate of growth while driving performance improvement in professional fee collections via process improvements, deployment of alternate/value-based payment models, 3rd party billing/collection management, and the creation of internal capabilities to the end of making revenue cycle management a competitive advantage for the organization.

The Revenue Cycle Director supervises the Posting, Reimbursement, Customer Service, Provider Enrollment, and Billing departments (internal and contracted) and maintains responsibility for the overall direction, coordination, and evaluation of these units.

RESPONSIBILITIES:

• Plans, directs, and manages the Reimbursement function to include but is not limited to:
  • Managing all accounts receivables.
  • Overseeing financial hardship approvals, patient portion write-offs and 3rd party collection efforts.
  • Managing payor websites and payer bulletins to stay abreast of policy changes that relate to Collections and Billing.
    

• Plans, directs, and manages the Billing function to include but is not limited to:
  • Overseeing all billing errors/edits related to claims processing to ensure timely release of claims.
  • Overseeing all coding and auditing projects working closely with compliance and performance improvement teams.
  • Customer and Stakeholder Interface, including but not limited to:
    • Executive Clinical Leadership.
    • Practice Management.
    • Compliance
    • Performance Improvement

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  Oversee Provider/Payer enrollment functions, which include:
  • Maintaining payer files for proper claim submission and accurate month end reporting.
  • Managing eligibility verification workflows, including claims-based eligibility denials.
  • Manages the education and orientation for new providers as it is related to the credentialing process.
  • Tight management and process controls for all aspects of Provider and Payor enrollment.

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  Present Monthly Financials and areas of opportunity to Executive Stakeholders.
• Interviews, hires, and trains employees.
• Plans, assigns, and directs work, appraises performance, rewards and disciplines employees, addresses complaints and resolves problems.
• Ensures compliance with regulations and billing and collections policies in order to facilitate attainment of AR targets.
• Establish an accurate model of program collection expectations and monitors those expectations with actual results.
• Performs ongoing trend analysis of third-party payer payment levels to ensure that reimbursement is in accordance with allowable amounts stated in agreements and contracts.
• Manages the review and negotiation of third-party payer contracts.
• Implements and monitors collection procedures, minimizing contractual and bad debt write offs, and maximizing cash collections.
• Provides financial support and analysis to leadership through communication and education.
• Oversees payment services including establishing and maintaining the practice’s fee schedules and fees that relate to managed care activities.
• Develops, implements, sustains and revises department policies and procedures as necessary.
• Stays abreast of and complies with all state and federal laws including HIPAA
• Manages integration of all new business acquired and organic growth.
• Maintains responsibility for productivity, quality, and timeliness of billing for all services rendered.
• Utilizes principles of continuous quality improvement to continually enhance performance and outcomes.
• Assists in development, maintenance, and reporting of Key Performance Indicators.
• Oversees development and implementation of monthly reporting/analysis functions.
• Maintains confidentiality of all Protected Healthcare Information as defined by HIPAA.
• Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.

QUALIFICATIONS:

The Revenue Cycle Director will possess the knowledge, skills, and abilities to lead the company’s reimbursement function during periods of exponential growth and scale within the national marketplace. These competencies include, but are not limited to:

• 5+ years of successful experience working with value/base care contracts
• 8+ years of progressive leadership experience in the Revenue Cycle Function of healthcare provider organizations.
• Master’s degree in business, finance, or related field strongly preferred. Bachelor’s degree required.
• Excellent understanding of Federal, State, and local compliance standards.
• Skill in examining, developing, reengineering, and recommending financial, AR, and technology policies and procedures to accommodate strategic objectives.
• Strong analytical skills and experience interpreting a strategic vision into an operational model.

COMPENSATION:

As a finance key leader and contributor for this rapidly growing organization, the Revenue Cycle Director will receive a highly competitive compensation package including variable bonus scheme.