Director, RCS Enterprise Clinical Denials (Registered Nurse)

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National Coalition of Healthcare Recruiters
Job Overview

(Only QUALIFIED Healthcare Professionals accepted) Nurse Management – Director, RCS Enterprise Clinical Denials (Registered Nurse)
Napa, California
JO# 28987

* Relocation Assistance *
* Bonus Eligible *

Provides leadership, direction, administrative oversight and change management towards continuous quality and efficiency improvement for revenue cycle functions of patient access, financial counseling, revenue integrity|CDM, health information management, payer contracting, reimbursement, accounts receivable and self-pay collections including optimal use of technology and vendor services.

Responsible and accountable to direct, manage, lead, evaluate and develop the systems and personnel for revenue cycle functions.
Develop, evaluate, monitor, improve and communicate key performance indicators for revenue cycle functions and prepares reports for CFO review and to support the annual financial audit. Develop, execute and maintain a detailed plan to improve revenue cycle performance and continually reduce days in accounts receivable, increase cash collections, reduce denials, reduce uncollectable write offs, improve patient and physician satisfaction.
Develop plans to ensure that claims submitted comply with industry-wide leading practice and the rules and regulations of CMS, Medicaid and other payers.
Directs and manages coding according to all HIPAA transaction set requirements and AHIMA ethical coding standards.
Conducts analyses of variances, rejections, denials and write-offs to identify problems, trends and root cause solutions.
Directs the development and implementation of goals and objectives for revenue integrity programs and processes (such as charge capture, compliance, Charge Description Master).
Incorporates best practices and responds to emerging trends to enhance operations, programs, and|or services.
Builds and maintains quality management and staff through thorough communication with leadership, other managers, staff and external sources, as needed.
Develops and recommends operational and capital budgets for functions.
Evaluates, negotiates and manages vendor|outsource services to support revenue cycle functions and optimal performance and customer service.
Leads analyses and negotiation related to payer contracting.
Researches and responds to physician requests for new products or procedure implementation at BAH; ensures that a requested product or procedure is not experimental, has federal approval, is within the scope of the Hospital’s Mission, Vision and Values and is projected to produce revenue.
Ensures daily operations support and complies with all regulations and reporting needs set forth by the state of Oregon, CMS, the Joint Commission, Medicaid and other related agencies

Bachelor’s Degree in Nursing or equivalent educ|experience required
10 years related experience in healthcare, revenue cycle or finance
MBA or MHA 10 years leadership experience, preferably with responsibilities that span multiple entities
Certified in Healthcare Compliance (HCCA)

Five years’ supervisor or managerial experience in a health care setting, preferably with revenue cycle functions
Five years’ experience working with registration, billing and financial data, accounts receivable, credit and collections, government and managed care reimbursement, and charge master|revenue integrity
Budgetary, documentation and reporting expertise

Job Detail
  • Job IDnchcr-2324402
  • StreetN/A
  • StateCalifornia
  • Postal CodeN/A
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