Accounts Receivable (AR) Management:
- Oversee all AR functions, including the monitoring of aging reports, follow-up on outstanding claims, and the resolution of unpaid balances.
- Develop strategies to reduce days in accounts receivable (DAR) and improve the overall cash flow.
- Ensure timely and accurate posting of payments and adjustments to maintain clean accounts and accurate financial records.
- Monitor and report on key performance indicators (KPIs) related to AR, such as collections rate, aging bucket performance, and AR days.
Denial Management:
- Develop and implement robust denial management processes to minimize claim denials and optimize revenue recovery.
- Analyze denial trends and work closely with coding, billing, and clinical teams to address root causes and implement corrective actions.
- Establish and maintain denial prevention strategies, including pre-claim submission audits and training programs for staff on proper documentation and coding practices.
- Work with insurance payers to negotiate and resolve denied or underpaid claims, ensuring maximum reimbursement.
Leadership and Team Development:
- Lead and mentor a team of AR specialists, denial management analysts, and billing staff, fostering a culture of continuous improvement and excellence.
- Set clear performance goals and provide regular feedback and coaching to ensure team members meet or exceed expectations.
- Conduct regular training sessions to enhance team members skills in AR management and denial resolution.
Compliance and Quality Assurance:
- Ensure compliance with federal, state, and payer-specific regulations and guidelines related to AR and denial management.
- Collaborate with the compliance team to conduct periodic audits and ensure adherence to best practices in billing, coding, and collections.
- Implement quality control measures to reduce errors and improve the accuracy of claims processing and payment posting.
Process Improvement and Technology Utilization:
- Identify opportunities for process improvements within AR and denial management to enhance efficiency and reduce operational costs.
- Work with IT and other departments to optimize the use of billing and AR management software, including EHR systems and other relevant tools.
- Stay updated on industry trends and changes in payer policies to proactively adjust processes and maintain high performance.
Financial Analysis and Reporting:
- Prepare and present regular reports on AR performance, denial rates, and revenue trends to senior management.
- Conduct financial analysis to identify opportunities for revenue enhancement and cost reduction within the AR and denial management functions.
- Develop and manage budgets for the AR and denial management teams, ensuring resources are allocated effectively to meet organizational goals.
Qualifications:
- Education: bachelors degree in healthcare administration, business, finance, or a related field. masters degree preferred.
- Experience: Minimum of 5-7 years of experience in revenue cycle management, specifically in AR and denial management, with at least 3 years in a leadership role.
Skills:
- Extensive knowledge of medical billing and coding, payer guidelines, AR management, and denial resolution.
- Strong leadership skills with experience managing teams and driving performance improvement.
- Proficiency in using RCM software, EHR systems, and data analytics tools.
- Excellent analytical, problem-solving, and communication skills, with a focus on data-driven decision-making.
Key Competencies:
- Leadership: Ability to lead and inspire teams to achieve organizational goals related to AR and denial management.
- Analytical Thinking: Strong analytical skills to assess data, identify trends, and implement effective solutions.
- Communication: Clear and effective communication skills to work with internal teams and external payers.
- Adaptability: Ability to adapt to changes in regulations, payer requirements, and industry trends.
