Reporting to the, the Administrator, Revenue Cycle, the Director of Ambulatory Management is responsible for managing the overall performance of the Ambulatory Revenue Cycle for the multi-specialty subsidiary of Flagler Professional Health Care Services, Inc., Flagler Health + Imaging Facilities, Flagler Surgery Centers, and ambulatory strategic partnerships JV’s and Professional Service Agreements.

The Director is responsible for the maximization of revenue and cash flow while maintaining the highest levels of patient, physician and employee satisfaction and relations. This includes management and oversight of business related functions of the patient visit from point of entry to accurate adjudication of the patient's account. The Director will ensure that front-end, mid-cycle, and back-end revenue cycle functions are optimized throughout the full revenue cycle.
Specific areas of responsibility include coding review, billing and collections, patient insurance data processing, denials management, integrity of patient accounts and accounts receivable management. This position includes a significant amount of multiple vendor performance management and coordination. This position is also responsible for the direction of these efforts in collaboration with Ambulatory leadership to ensure the accuracy and timeliness of charge capture, coding, claims submission, follow-up, denial and underpayment management.

This position will also be responsible for overseeing Provider Enrollment team. Ensuring Enrollments for both facility and ambulatory services are completed accurately and timely.

Essential Responsibilities

• Manages the daily operations for all Ambulatory Enterprise Revenue Cycle personnel in the areas of insurance verification, compliance, scheduling of surgical procedures, and transcription of operative procedures.
• Provides support to the managed care and credentialing departments in efforts to reduce the length of time it takes for new providers to be credentialed and active with governmental and commercial payers.
• Manages the Flagler employees associated with the revenue cycle and Payor Enrollment services of the Ambulatory and facility Enterprise.
• Serves as an auditor and consultant for revenue cycle management with the Professional Services Agreements that fall under the Ambulatory Enterprise portfolio.
• Supervises and serves as a resource for Ambulatory Revenue Cycle personnel: orientation, maintenance of business office personnel records, evaluation of employee performance, and assessment of employee training needs. Audits time, PTO, and other general functions of maintaining and scheduling of personnel to coordinate the daily operational flow. Recruits and hires staff as needed.
• Maintains appropriate and accurate accounts-payable financial records. Reviews delinquent accounts with administrator before sending to collection, according to facility policy/procedure.
• Remains current on all federal and state guidelines regarding business office practices (e.g., fraud, abuse, and antikickback statutes). Ensures that financial transactions follow generally accepted accounting principles and facility policy.
• Ensures coding and billing of surgeries is performed in a timely and accurate manner. Monitors A/R days and implements processes to reduce past due accounts. Overseeing/performing collection activities to ensure that claims are filed promptly, payments are received promptly and that payments are paid according the contracts on file. Monitors credit balance report and reviews refund process to ensure timely and accurate refunds.
• Coordinates with providers to obtain all medical documentation for developing database information for practitioners. Analyze information obtained to insure completeness of file database and perform all follow-up activity to maintain current provider credentials and payor files for the enterprise. Follows up on updates and maintains provider data within CAQH and NPPES data banks.
• Serves as liaison with Medicare, Medicaid, and other third party payors, attending, as needed, workshops or seminars to remain abreast of current rules for coding, filing and collection of claims.

Education / Training

Degree/Diploma Obtained Program of Study

Bachelor's Degree in Business Administration, Healthcare Administration or related field.
and/or
Bachelor's Degree and Minimum of (5) years of relevant work experience will be accepted. At least 3 years in relevant leadership role.

Experience Requirements

• 5 to 7 years Revenue Cycle Operations/3 Years Leadership role

Preferences

• Preferred: Experience with multiple EMR’s preferred.
• Mastery of Microsoft Excel and other modeling tools
• Ability to work as a team member and effectively develop working relationships with multiple corporate departments and surgical facility locations
• Ability to analyze and provide results to various level of management within and outside of the department
• Experience managing multiple projects with varying deadlines.
• Experience working in denials management and contract data analysis

Preferences:

• Certified Professional Coder or Equivalent preferred but not required
• Certified Coding Specialist-Physician Based (CCS-P) and or CPC, Certified Professional Coder or equivalent preferred but not required