Director of Revenue Cycle Management

At OrthoCarolina, our team is our greatest asset and the foundation of our success. We are a diverse group of individuals, accountable to each other to uphold the standards of excellence and promote an environment of teamwork throughout the organization.  OrthoCarolina has 43 unique care locations with over 1300 professionals who share a common goal to make lives better. Our employees are eligible for a full spectrum of benefits including paid company holidays, wellness programs, and tuition reimbursement. To learn more about Team OC please visit  https://www.orthocarolina.com/about-us 

We are seeking a Director of Revenue Cycle Management (Medical) to work with our team in the OrthoCarolina Business Office. 

The Director of Revenue Cycle Management provides management, vision and administrative direction to the following departments within Business Services:  Accounts Receivable, Billing Support, Data Coordination, Contract Validation, Credentialing, and Customer Service.   This will include confirming that each department has the proper operational controls, reporting procedures and personnel in place to effectively ensure efficiency in business operations and plan for long-term growth and expansion.  

Essential Functions: 

• Within Accounts Receivable working with the AR Manager to ensure that accounts are worked in a timely manner, maintain low AR Days, and resolve systemic issues that cause lags in claims payment.  

• Oversees the surgical denials and appeals processes by working closely with Appeals Specialists; Monitors and reports the appeals process including the successful financial recovery of improperly denied claims. 

• Assists with maintaining Charge Review edits to reduce denials; often maximizes technology to reduce edits. 

• Within Data Coordination working with the Data Coordination Manager to ensure that electronic and paper payment files are posted in a timely manner and maximize the use of technology to reduce errors and ensure payment/adjustment integrity. 

• Work closely with bank vendors to maximize electronic efficiencies related to EFT/ERA reconciliation and 835 conversions. 

• Within Customer Service ensuring that customer calls are being handled in a timely manner and accurately.  Works very closely with the Customer Service Manager to process Collection accounts, statement generation, patient payment processing, etc. 

• Within Credentialing Department working with the Credentialing Manger to ensure that providers are credentialed with payers in a timely manner to avoid unnecessary denials or delayed revenue. 

• Collaborating with the Contract Validation Manager in order to identify payment variances and to recover revenue due to incorrect payer processing.    

Qualifications: 

• Bachelor of Science in health or business administration or related course of study or 7 years of healthcare management experience. Master’s degree preferred. 

• Minimum 10 years of management in a healthcare business office setting. 

• Minimum 5 years working in Epic Resolute (preferred) or comparable enterprise billing system.