Associate Director- Revenue Cycle Hospital Billing

Job Family:

PFS General

Travel Required:

None

Clearance Required:

None

The Hospital Billing Associate Director – Revenue Cycle is responsible for overseeing the teams who handle the daily operations of the hospital billing to ensure timely, accurate, and compliant submission of facility claims. This position provides day-to-day leadership and technical guidance to billing staff, monitors billing productivity and quality, manages claim edits and billing holds, and works collaboratively with internal departments and payers to resolve issues that delay claim submission or reimbursement.

The Associate Director is responsible for ensuring established billing goals and client service level expectations are achieved while maintaining compliance with federal, state, payer, and organizational requirements. This position also identifies billing trends, implements process improvements, supports staff development, and communicates operational issues and recommendations to management.

 

Essential Job Functions

·          Hospital Billing Operations

·          Staff Leadership, Training, and Development

·          Claim Edit and Billing Hold Management

·          Billing Quality and Compliance

·          Payer Issue Resolution and Escalation

·          Productivity and KPI Management

·          Reporting and Process Improvement

·          Cross-Functional Collaboration

 

Duties and Responsibilities

Leadership and Staff Management

·     Provides daily leadership, direction, coaching, and support to hospital billing staff.

·     Promotes a professional, collaborative, and accountable work environment.

·     Sets clear expectations for productivity, quality, attendance, and performance.

·     Monitors individual and team performance against established operational goals and KPIs.

·     Provides ongoing training and education regarding billing requirements, payer updates, regulatory changes, and departmental procedures.

·    Identifies employee development opportunities and provides timely coaching and feedback.

·     Ensures staff have the tools, training, system access, and operational knowledge necessary to perform their responsibilities successfully.

·     Conducts regular team meetings to communicate operational updates, performance results, payer changes, and process improvements.

·     Escalates staffing, performance, compliance, and operational concerns to management when appropriate.

    

Hospital Billing Operations

·     Oversees daily hospital claim billing activities to support timely and accurate submission of clean claims.

·      Ensures claims are generated, reviewed, corrected, and released according to established billing timelines.

·      Monitors billing work queues, claim edits, claim holds, and unbilled accounts to identify barriers to timely claim submission.

·      Ensures billing staff appropriately resolve edits or route accounts to the correct department when additional information or correction is required.

·      Monitors electronic claim submissions, payer rejections, clearinghouse edits, and billing exceptions through resolution.

·      Oversees corrected, replacement, and adjusted claim workflows as appropriate.

·      Ensures billing staff accurately document actions taken within the patient accounting system.

·      Monitors reconciliation activities to ensure claims released from the patient accounting system have successfully progressed through the billing process.

·      Ensures billing issues are researched and resolved timely and appropriately escalated when necessary.

·      Works with payers, clearinghouses, internal departments, and other stakeholders to resolve recurring billing issues.

·       Identifies systemic billing issues and partners with appropriate departments to develop corrective action plans.

        

Billing Quality and Revenue Cycle Performance

·       Monitors billing accuracy, claim quality, productivity, and timeliness.

·       Reviews work queues and operational reports to identify trends, backlogs, aging inventory, and opportunities for improvement.

·       Develops action plans to reduce billing delays and prevent avoidable rework.

·       Performs or coordinates quality reviews to ensure staff adherence to established billing procedures.

·       Identifies root causes of recurring claim edits, rejections, and billing delays and works with appropriate teams to implement sustainable solutions.

·       Monitors key billing performance indicators and implements strategies to improve performance.

·       Ensures assigned billing inventories are worked according to established prioritization and aging expectations.

·       Communicates significant operational trends, barriers, and risks to management.

 

Payer and Interdepartmental Collaboration

·       Serves as an escalation point for complex hospital billing issues.

·       Collaborates with Patient Access, Health Information Management, Coding, Utilization Management, Revenue Integrity, IT, and other revenue cycle departments to resolve issues affecting claim generation and submission.

·       Partners with payers and clearinghouses to research and resolve recurring claim submission and rejection issues.

·       Communicates payer billing changes and requirements to staff and affected departments.

·       Works with IT and system support teams to investigate system issues affecting claim accuracy or timely billing.

·       Supports implementation and testing of system or workflow changes impacting hospital billing.

 

Regulatory and Billing Compliance

·       Ensures billing activities comply with applicable federal and state regulations, payer requirements, and organizational policies.

·       Maintains working knowledge of Medicare, Medicaid, and commercial payer billing requirements applicable to hospital/facility claims.

·       Ensures staff are educated on appropriate billing practices and compliance expectations.

·       Identifies potential billing or compliance concerns and promptly escalates them to management and appropriate compliance resources.

·       Supports internal and external audits and assists with implementation of corrective actions when required.

·       Ensures appropriate patient account documentation and adherence to established authorization and adjustment policies.

 

Reporting and Performance Management

·       Prepares, reviews, and distributes daily, weekly, and monthly hospital billing reports.

·       Monitors key performance indicators such as:

·       Billing productivity

·       Billing turnaround time

·       Unbilled account volume and aging   Claim hold volume and aging

·       Claim edit inventory

·       Claim rejection volume and trends

·       Billing quality and accuracy

·       Staff productivity and quality

·       Reviews trends and develops actionable plans to address performance gaps.

·        Provides management with timely updates regarding significant billing barriers, backlogs, payer issues, and operational risks.

·        Ensures required reports, reconciliations, and assigned projects are completed accurately and timely.

 

Process Improvement

·        Continuously evaluates hospital billing workflows for opportunities to improve efficiency, quality, and claim turnaround.

·        Identifies recurring process failures and works with appropriate stakeholders to determine root causes and corrective actions.

·        Assists in developing and maintaining standardized billing procedures, workflows, and training materials.

·        Encourages staff participation in identifying workflow improvements.

·        Supports implementation of new technologies, payer requirements, system enhancements, and revenue cycle initiatives.

 

What You Will Need:

• Bachelor’s degree and a minimum of ten years of relevant experience or High School Diploma and fourteen years of relevant experience
• Minimum of four years of leadership, supervisory, or people-management experience.
• Management of multiple facility posting data
• Knowledge of financial institution on EFT conversion
• Extensive knowledge of blended payments (hospital billing, physician billing, vendor payments, general ledger transfers)
• Hospital/facility billing or Patient Financial Services experience.
• Strong understanding of hospital revenue cycle operations and accounts receivable.
• Working knowledge of government and commercial payer billing requirements.
• Ability to manage competing priorities and make timely operational decisions.
• Ability to communicate effectively with staff, management, clients, payers, and cross-functional departments.

  

What Would Be Nice to Have:

• Extensive hospital billing experience.
• Experience with Epic Hospital Billing (HB), Meditech 6 and/or Meditech Magic.
• Experience managing claim edit and billing work queues.
• Knowledge of Medicare and Medicaid hospital billing requirements.
• Familiarity with CPT, HCPCS, ICD-10, revenue codes, claim forms, and hospital reimbursement methodologies.
• Experience working with billing scrubbers, clearinghouses, electronic claim submissions, and payer portals.
• Experience developing or monitoring hospital billing KPIs and productivity standards.
• Intermediate to advanced Microsoft Excel skills.

#LI-DNI

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

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