Director of Revenue Cycle
Philadelphia
Finance /
Full-time /
Remote
Planned Parenthood Keystone (PPKey) serves 37 counties in Pennsylvania, home to over half of Pennsylvania residents. We have administrative offices in the Lehigh Valley, Harrisburg, Warminster, and York. We operate 7 medical centers that serve over 30,000 patients annually and offer comprehensive sexuality education that reaches thousands of young adults.
Planned Parenthood Keystone is looking for individuals who are committed to supporting our shared goal of strengthening and enhancing our awareness and commitment to advancing the cause of racial & social justice in our organization.
The Revenue Cycle Director leads the billing operation of PPKeystone by providing operational leadership, oversight, evaluation, analysis, and direction to enable sustainable growth of the affiliate’s client base, revenue, and market share in a manner that is consistent with the overall mission, goals, and objectives. Supports and guides any direct rev cycle department staff and acts as primary liaison between outsourced billing vendor, self-pay vendor, credentialing vendor, MTS, CHN, and the affiliate's clinical and operations staff. Coordinates with Medical Services management and staff to optimize and maintain compliance with the billing-related functions conducted in the medical centers.
Identifies and evaluates opportunities for new revenue sources and lost revenue through analysis of revenue cycle metrics, payment and denial analysis as well as strategic partnerships and business development. Identifies, develops, and implements performance metrics and provides ongoing analysis and tracking to Executive, Finance, and Medical Services management.
Essential Duties and Responsibilities
- Review, revise, and/or implement policies and procedures for all revenue cycle processes, collaborating with Medical Services and the billing /self-pay/credentialing vendor, MTS and CHN as appropriate, to ensure that the affiliates are maximizing billing and collections, while remaining in compliance with federal/state and HIPAA privacy and security regulations and the terms of our payer contracts, and in alignment with Planned Parenthood’s mission. This includes pricing, coding, charge entry, claim submission, payment posting, denials management, bad debt & collections, appeals processing, credit balance resolution, and accounts receivable management
- Act as a key liaison between outsourced billing/self-pay/credentialing vendor, MTS and CHN, and the affiliate. Ensure that the vendors/MTS/CHN receives all applicable information to process accurate claims and provide required detailed data as well as synthesize it into key messages via executive dashboards and reports
- Oversee the work of the billing vendor including audits of their work and regular review of their processes to ensure accuracy and compliance with their contract
- Oversee third-party contract negotiations, management, and payer relations
- Work closely with the Medical Services and training departments 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
- 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
- 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 Medical Services Leadership, including Health Center Managers, to ensure that information collected, gathered, and entered into the practice management system is accurate and that patient balances and unapplied payments are being reviewed and corrected regularly
- Collect, review, and correct patients’ accounts for all services including family planning, abortion services, women's health, and other reproductive health services
- Provide support for all grants, including the Title X program. Ensure tasks related to Title X and other grant’s productivity and financials are aligned with the strategic mission
- Ensure a culture that embraces diversity, fair and respectful treatment of all persons, and customer-focused
- Ensure completion of required annual training
- Adhere to all HIPAA and patient privacy regulations
Education and or Experience
- Bachelor’s degree in accounting, finance, or related field.
- Minimum of seven years of reimbursement experience managing a billing operation in an automated medical practice management environment
Minimum Qualifications
- 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-9 billing codes
- Strong knowledge of Pennsylvania State Medicaid programs and regulations
- Excellent analytical and strategic thinking abilities. Able to see ahead clearly and produce winning strategies
- Well organized. Keeps things on track by setting tight priorities and timelines.
- Strong oral and written communication skills. Able to present ideas clearly, convincingly and concisely
- Advanced collaboration skills and ability to motivate and work well with a diverse group of staff
- High degree of proficiency in financial systems, Excel, Word and PowerPoint. Ability to learn and master financial systems quickly
- Ability and willingness to travel. Reliable means of transportation
- Computer literacy, including competency in affiliate email, Internet, and patient management systems software
- Strong commitment to quality healthcare and excellent customer service
Physical Demands and Work Environment
- To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Successfully meeting the physical demands listed below are also essential function of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.
- Continuous ability to read, speak, hear, and see
- Infrequent exposure to outside weather, and heat or cold conditions
- Continuous exposure to moderate noise level
- Ability to lift and move up to 25 pounds
Salary and Benefits
- Compensation for this position starts at $80,000/annually and goes up from there based on experience.
- Medical, Dental, and Vision coverage options for you and eligible dependents
- Life/AD&D and Long Term Disability, Short Term Disability policy voluntary coverage options
- 401 (k) Retirement plan with employer match
- Generous vacation, leave, and holiday benefits
Planned Parenthood is an equal employment opportunity employer. We comply with all applicable laws prohibiting discrimination based on race, color, religion, gender and gender expression/identity, age, ethnicity, national origin, ancestry, physical or mental disability, uniformed service member/veteran status, marital status, medical condition, pregnancy, sexual orientation, citizenship status, genetic information, as well as any other category protected by federal, state, or local. We are committed to building an inclusive workplace that values racial & social justice. We strongly encourage all persons to apply, including people of color and members of the LGBTQ community.
