Director of Revenue Cycle

Join Orthopedic Specialists of SW Florida as Director of Revenue Cycle Operations, where you will play a crucial role in overseeing and optimizing the operational aspects of our Billing Department. With a focus on the oversight of the revenue cycle to maximize revenue utilizing the most innovative and effective processes

About OSSWF:

Orthopedic Specialists of SW Florida has been a cornerstone of orthopedic care in the Fort Myers area for over 23 years. Our practice boasts a team of 16 fellowship-trained orthopedic surgeons specializing in various subspecialities. We are committed to excellence and continued growth, offering comprehensive services including onsite Physical Therapy/Occupational Therapy, MRI, and digital X-ray. We prioritize patient care and strive for the highest standards of service.

Orthopedic Specialists of SW Florida’s state-of-the-art, 60,000 square-foot facility incorporates the latest in leading-edge technology in order to provide optimal care for patients who have bone, joint, muscle and spine problems. Our office includes five Centers of Excellence and a full Physical Therapy and Occupational/Hand Therapy division, which work in close coordination with our physicians to provide non-operative, preoperative, post-operative and preventive care.

Responsibilities:

• The Director, Revenue Cycle Operations will be responsible for managing Orthopedic Specialist of SW Florida medical billing, insurance and patient collections and related support activities
• Initial priorities will include developing the strategic vision, selecting third-party billing partners and executing billing initiatives
• Future priorities will include fine-tuning the operating activities to optimize revenue collections as well as develop key service and support metrics
• In this role, the Director, Revenue Cycle Operations will work closely with executives, directors, physicians, and managers as well as third parties
• Hands-on management of all billing programs, systems, processes, and third-party vendors to ensure accurate, timely and well-controlled activities related to billing, collections, education, and support
• Prepares daily, weekly and monthly RCM reporting metrics to remediate any items outside established KPI including status report of projects
• Effectively implement denial management reduction through process improvements, coordinating direct or indirectly, with internal team and offices to improve workflows and provide training and education
• Maintain understanding and communicates payor policy changes across the market
• Responsible for Worker’s compensation relations and statutory changes
• Promote positive attorney relations, stay current with PIP laws, and negotiate personal injury case settlements
• Meet with payor representatives for timely remediation of large denial or underpayment projects
• Formulate and execute policies and procedures to ensure the billing workflow is highly effective
• Daily reviews of the following programs: Incoming claim/denial volumes, daily billing, rejections, evaluate clean claim rates, and team workflow
• Presents first-line negotiation of payer contracts on an annual basis to the CEO and CFO
• Evaluate and communicate fee schedule changes, or changes that affect payments annually
• Annual charge master analysis and implementation
• Develops quality control program to meet the company's quality initiatives
• Ensure productivity goals are monitored and quickly re-mediates barriers to achieving those goals at the individual and/or team level
• Counsels and disciplines employees in accordance with department goals and policies
• Maintain compliance with directives from all regulatory agencies and third parties
• New provider onboarding, train on billing processes, also working in coordination with credentialing supervisor
• Ensure staff compliance with coding, PCI, insurance company policy changes
• Collaborate with other departments to maximize training and efficiency
• Maintain department compliance with state and federal regulations
• Required to attend all executive meetings
• Attend conferences pertaining to orthopedics or billing at the discretion of the CFO

Minimum Requirements (education, experience, special skills and licenses or certifications required):

• 10+ years of managerial experience in healthcare revenue management cycle roles with experience in all phases of the revenue cycle management.  Orthopedic experience preferred.
• Experience with Modernizing Medicine EMR and billing system preferred
• Experience with a large group, growing healthcare organization support
• Extensive knowledge of patient registration, coding, billing, regulatory requirements, billing compliance, business operations, financial systems and financial reporting
• Strong work ethic, attention to detail, knowledge of the claims process, coding, billing, collections and credentialing