Job Summary

The Director, Accounts Receivable is responsible for overseeing and coordinating all accounts receivable activities with a goal of maximizing reimbursement in a cost-effective manner. The Director will oversee the overall policies, objectives and initiatives for our company's accounts receivable and collections activities. This individual will work with our outsourced vendor to coordinate all accounts receivable work efforts. Ensures compliance with state and federal laws and regulations for managed care, government programs and other third-party payers. Monitors all RCM processes to determine improvement opportunities and encourages team-based results.

This position may be done remotely, but the individual will need to reside in either Pacific or Mountain time zone, to align with west coast operations. Travel to Cerritos will be required from time to time.

Essential Functions:

In collaboration with the Senior Vice President and RCM Director, the Director, AR, will coordinate oversight of AR processes in accordance with established internal and third-party payer requirements:

• Provide strategic direction, lead innovations and operational enhancements/standardization by leveraging best practices and technology to create best in class corporate accounts receivable insurance billing operations.
• Demonstrate strong strategic thinking, collaboration, leadership, problem solving and communication skills with all levels of the organization, payors and the RCM Vendor.
• Collaborate with payors and internal stakeholders including the third-party Vendor to build and implement strategies around first pass accurate payment rate and improve overall operational efficiency.
• Develop strong relationships with payors and collaborate with them to resolve any outstanding claims which have been escalated.
• Oversee, monitor and control all activities related to patient and insurance accounts receivable, which includes collections, customer service, and denial management.
• Supervise and coordinate the accounts receivable management function to consistently yield accurate and timely payments on our claims based on regulatory and payor contractual guidelines.
• In conjunction with the SVP RCM, develop KPIs and dashboard reports to monitor and benchmark AR performance. Set internal goals for KPI metrics.
• Develop and implement improvement plans for underperforming KPI benchmarks and internal goals
• Lead RCA & Prevention Strategies to reduce Denial percentage and improve timely and accurate payment

Team Leadership and Development, in coordination with Human Resources as appropriate:

• Coordinate the recruitment and orientation of team members
• Mentor, cross-train, and develop skill set among team members, conducts weekly account reviews, team meetings and 1:1s
• Conducts performance reviews, establish and monitor individual goal achievements
• Utilize internal and external systems and/resources for training
• Comply with and educate team members on relevant state and federal regulations (e.g., Department of Managed Care Health & Safety Law)
• Work with leadership teams to enhance overall department processes, performance, and quality results

Administrative Management

• Oversee administrative functions related to staff management including timecard approvals, vacation and sick time requests, and employee changes
• Facilitate preparation of scheduled reports to management
• As an exempt position, evening and/or weekend hours may be required to ensure the fulfillment of all duties and responsibilities
• Other duties as may be assigned or modified, or alternate work schedule

Managerial Responsibilities

Directly supervises 4 staff who perform patient financial assistance. This position carries out managerial responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training direct reports; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Education and Experience:

• 5+ experience in healthcare industry (Health Plan, IPA/MSO, Provider)  
• 5+ years of experience in collection and credit work  
• 5+ years of leadership experience in Revenue Cycle Management.  
• Claims experienced preferred.
• Experience managing external vendors.  
• Bachelor's degree in healthcare management is preferred.
• Billing experience is preferred. 

Required Skills/Abilities:

• Strong computer skills, including Microsoft Office suite
• Strong Payor Contract interpretation background  
• Experience with one/multiple EMR and RCM software program(s)
• Strong understanding of statistics and data analysis
• Strong knowledge of Claims billing function, ICD-10 diagnosis codes, CPT/HCPC procedures codes
• Strong knowledge of healthcare billing laws, rules and regulations
• Strong understanding of applicable state and federal collection laws including the Fair Debt Collection Practices Act and the Fair Credit Reporting Act.

Demands/Requirements:
(The demands described here are representative but not all inclusive of those needed to successfully perform the essential functions of this job.)

• Prolonged periods sitting at a desk and working on a computer.
• Frequent use of upper extremities for reaching, lifting or transporting materials.
• Able to lift, carry or move up to 15 pounds at times.
• Frequently communicate with others, must be able to exchange accurate information.
• Regular periods of moving throughout office.
• Occasionally kneels, crouches, bends or stoops while effectively maintaining balance.
• Effectively and frequently operate standard office equipment, including a computer with various software programs.
• May be required to work irregular hours, including but not limited to nights or weekends.
• Performs other duties as assigned.