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1. Revenue and Assurance Director
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EDUCATION AND EXPERIENCE
- He/she a Bachelor’s must have Finance, Accounting, Economics or a related Fields.
- A Master’s degree or professional certification (e.g., CPA, ACCA) is added advantage.
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He/she must have Proven experience (5 years) in revenue assurance role, Finance, Accounting, Revenue cycle management, preferably in a managerial or supervisory role.
SKILLS AND ABILITIES
- Financial Acumen: Profound financial expertise with a keen understanding of revenue cycles, accounting principles, and financial analysis to identify revenue optimization opportunities and potential risks.
- Analytical Skills: Strong analytical capabilities to interpret complex financial data, perform trend analysis, and generate insights for revenue enhancement strategies and risk mitigation.
- Leadership and Management: Exceptional leadership abilities to manage a team, set goals, and guide them in executing revenue assurance initiatives effectively. Capable of fostering a collaborative work environment.
- Regulatory Compliance: In-depth knowledge of healthcare regulations, billing guidelines, and compliance standards (such as HIPAA) to ensure adherence and mitigate regulatory risks related to revenue operations.
- Problem-Solving: Advanced problem-solving skills to identify and address revenue leakage, billing inaccuracies, and process inefficiencies within the revenue cycle, devising effective solutions.
- Communication and Collaboration: Excellent interpersonal and communication skills to collaborate with cross-functional teams, convey complex financial information effectively, and liaise with internal and external stakeholders.
- Attention to Detail: Meticulous attention to detail when reviewing financial records, conducting audits, and implementing controls to ensure accuracy and integrity in revenue-related processes.
- Strategic Thinking: Ability to formulate and execute long-term revenue assurance strategies aligned with the hospitals financial objectives, driving continuous improvement and optimizing revenue streams.
- Technology Proficiency: Familiarity with financial software, data analysis tools, and ERP systems to facilitate financial reporting, analysis, and process optimization within the revenue cycle.
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Leadership and Team Management
- Lead, mentor, and manage the Patient Business Services unit, Billing and Recovery unit, and Revenue Assurance.
- Develop and maintain a high-performing team by setting clear goals, providing regular feedback, and fostering a culture of collaboration and accountability.
- Conduct performance evaluations, provide feedback, and support staff development and training initiatives.
- Provide ongoing coaching, mentorship, and performance evaluations to ensure staff effectiveness and productivity.
- Foster a collaborative and productive work environment.
Strategic Revenue Assurance
- Develop and implement a comprehensive revenue assurance strategy to maximize revenue while ensuring compliance with relevant regulations.
- Analyze revenue trends, identify potential revenue leakage points, and create strategies to address them.
- Collaborate with senior leadership to align revenue assurance efforts with the hospital’s strategic goals.
Billing and Recovery Oversight
- Oversee the Billing and Recovery unit in managing billing processes, claims submission, and revenue recovery efforts.
- Ensure the timely and accurate submission of claims to insurance companies, government payers, and other third-party payers. Oversee the billing and timely submission of claims to insurance companies, government and private payers.
- Implement strategies to reduce denials and underpayments.
- Ensure all billing and coding practices adhere to relevant laws and regulations.
- Develop and implement strategies to optimize the hospital’s revenue cycle, including reducing denials and improving collections.
Compliance and Regulatory Adherence
- Stay updated on healthcare regulations and payer requirements to ensure compliance with the hospital’s billing practices.
- Collaborate with the Compliance department to develop and implement policies and procedures that adhere to regulatory standards.
- Conduct periodic audits to identify compliance issues and implement corrective actions.
Financial Analysis and Reporting
- Monitor and analyze key revenue performance indicators, such as accounts receivable, charge capture, and revenue recovery rates.
- Prepare and present regular reports to senior leadership, including the CFO, on revenue assurance performance and recommendations for improvement.
6. Process Optimization
- Identify opportunities to streamline and optimize revenue assurance processes for greater efficiency and accuracy.
- Collaborate with Information Technology to leverage technology solutions that enhance billing accuracy and reduce revenue leakage.
- Continuously assess and improve revenue cycle processes to enhance efficiency and accuracy, reducing denials and write-offs.
- Identify and implement technology solutions and software tools to streamline revenue cycle operations.
- Lead and develop quality improvement projects, policies, and procedure development and review.
- Identify areas where staff may require additional training or support for enhanced billing processes.
7. Patient Business Services Management
- Lead the Patient business services team to ensure smooth and efficient patient billing processes.
- Address patient inquiries and concerns related to billing and insurance matters.
8. Customers Management
- Oversee relationships with external customers and third-party partners involved in revenue cycle management.
- Evaluate customer performance and negotiate contracts to ensure cost-effectiveness and service quality.
9. Training and Development
- Develop and deliver training programs for staff in the Revenue Assurance, Billing and Recovery, and Patient Business Services units.
- Keep staff informed of industry trends, best practices, and regulatory changes.
10. Contract management
- Ensure that all partners have valid contracts.
- Ensure that expired contracts are renewed to the existing policies, laws, and regulations of the hospital.
- Lead the discussion with new partners.
11. Tariff management
- Lead the discussion for establishing and reviewing hospital tariffs for new and existing services.
- Ensure the accuracy and implementation of the hospital tariff.
12. Revenue Optimization and Analysis
- Analyze billing data to predict revenue streams and identify potential areas for revenue growth.
- Monitor and follow up on outstanding payments, devising strategies to minimize overdue accounts.
- Optimize cash flow by ensuring timely invoicing and efficient collection processes.
- Collaborate with finance departments to analyze billing data and contribute to financial planning strategies.
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