Revenue Cycle Director in Managed Care - Personal Statement Example

Working as a Revenue Cycle Director in Managed Care al Affiliation) As the director of revenue cycle in a managed care facility in Boston, I am responsible for vendor management operational management relating to professional billing, managing contracts and providing enrollment. However, my duties are not limited to just these duties as there are other additional duties that I am responsible for, which are mostly of an oversight nature. I oversee other third parties like collection and billing vendors. Usually, my additional duties are at the discretion of the Revenue Cycle Vice President. As par the wishes of the Vice President, I am tasked with verifying, reviewing and updating all information relating to the demography on the managed care’s database, SoundConnect, which is primary a care service provider. One a day to day basis, my core duties include:- i. Evaluating equipment, systems and staffing so that they meet the set standards of business. I provide assessments, appraisals and recommendations to the Chief Financial Officer and other top level management. After I send my recommendations, they are then responsible for making the appropriate changes. ii. Ensuring that processing claims are up to the industry standards. I ensure that the claims meet Medicaid, Managed Care and Medicare standards. iii. Implementing and creating procedures and policies concerned with the revenue cycle mechanism. iv. Monitoring the productivity of all the departments. These productivity metrics include claims that have been rejected, denied or processed. It also includes collection volume, payments of patients, rates of fee schedules and account write offs. v. Ensuring that the staff attends training programs for specified functions. Through reviewing the staff, I am able to gauge their job proficiency. Additionally, I schedule staff meetings aimed at enhancing staff development and improving communication. vi. Appraising and supervising performance. Since I am essentially a manager, I make sure that direct reports continuously improve the skills and knowledge of the staff. vii. Using the billing system and systems of collection for processing and billing. I am an accountant by profession and therefore I ensure that the billing systems are utilized by the staff at the care. I also conduct training programs to make sure that proficiency testing for all staff is established. viii. Monitoring data management systems to make sure that claims are completed on time. I ensure that I monitor the systems for appeals, filings, and collection outsourcing and compliance responses. Friedman et al., argues that, the revenue cycle director is part of the managerial staff and as such, is involved with contributing to the vision and strategic strategies that a managed care facility adopts. Therefore, the director sets the strategy and vision in alignment with the goals and initiatives of the critical revenue cycle for every business line (Friedman et al., 2013). As the director, I provide the strategy and vison for the Pain Center, Home Health, Orthopedics and the Ambulatory Surgical Center. My job extends to managing and leading intrinsic revenue cycle projects. I perform this role by providing the total oversight and direction of the core areas that support the facility’s operational and financial goals. In conjunction with my support staff, I ensure that the facility and its employees comply with standards set for 3rd party payers, OSS policies and CMS regulations. I believe that my work has helped promote and foster the culture of customer service excellence. I also need to emphasize that my office cannot survive on its own, and it requires the assistance of other departments. Hitchcock et al., is of the opinion that, the inter-departmental cooperation aids in ensuring that the operational activities and functions of the facility, are in alignment with the organization’s goals and vision. In addition to the above, I as a top tier managerial staff try to build partnerships and trust among the departments, in order to address matters of performance and compliance since enforcing compliance measures is not very popular in other departments (Hitchcock et al., 2009). Personally, I am a rebel by nature and I accidentally stumbled on this career path. I studied Business Administration, but only with the intention of joining my father’s oil transportation firm and eventually succeeding him. In fact, I worked there for close to five years after graduating from college. However, during that period, my grandfather become terminally ill with pancreatic cancer and was hospitalized at a managed care facility in the Boston area. At the facility, I was able to see the mismanagement in the facility which ranged from incorrect billing systems, poor customer service and through queries, I was able to ascertain that the care had adopted an inefficient database system. I realized that I was not making any impact at my father’s company and I could contribute towards changing the management style of a facility that was responsible for hundreds of lives. Therefore, I joined the facility as a junior accountant and after five years, due to my previous experience at my father’s firm, I was promoted to Assistant Revenue Cycle Director, where I stayed for an additional five years and gained invaluable experience. Two years ago, the interim director retired and I successfully applied and got selected for the Director’s job. Since I am involved in mentoring staff, I would like to provide the following information for any potential applicants of this job. In terms of professional qualifications, any potential candidate must meet the criteria below:- a. At least a Bachelor’s degree in HealthCare/Business Administration. However, due to the competitive nature of the job, it is advisable that a candidate possesses a Master’s degree in HealthCare Administration. b. A deep knowledge of HIPAA standards, claims management, managed care, CMS requirements, HCPCS ICD-9, ICD10 and CPT coding. c. A minimum of three years continuous experience in management and supervision in a healthcare facility. The candidate should have a proven track record in managing a team with successful results. d. A minimum of 10 years working experience in a healthcare facility. Additionally, the experience should primarily be in a revenue cycle set up. e. Detailed knowledge of security operations, access to information, healthcare compliance, security and privacy regulations. f. Strong time management capabilities. g. A proven track record of selecting process improvement opportunities. h. Strong managerial and leadership skills coupled with the ability to analyze, negotiate, guide, interact, and direct management and auxiliary staff. i. Experience in developing and managing a balanced scorecard effectively. The experience should however be demonstrated in a managerial position with positive outcomes. j. Comprehensive experience in negotiation, analysis and management of payer contracts. k. A demonstrated comprehension of governmental reimbursement effect and quality programs. l. Solid communication network with vendors, top level management, physicians and other departments in a healthcare facility. m. Experience in using measurable results and quantified data to make relevant and sound conclusions. According to Dunn et al., in order for one to be a successful revenue cycle director in any managed care facility, one must possess the following skills:- a. Deep knowledge of the revenue cycle of a managed care, healthcare payment models, practice management of physicians, payer contracting and models of different managed care. The knowledge should be on a working basis since theory differs from the actual conditions. b. Exemplary organizational and analytical skills. c. Excellent oral communication and written skills. d. The capability to prioritize tasks and multitask. e. The ability to withstand pressure in a highly competitive environment. f. The ability to make decisions quickly and efficiently. g. Self-motivation is a key skill that one should have. The candidate should be analytical with a proven record as a problem solver. h. The ability to effectively communicate with employees from different levels of the organization (Dunn et al., 2010). References Dunn, R., & Haimann, T. (2010). Dunn & Haimanns healthcare management (9th ed.). Chicago, Ill.: Health Administration Press. Friedman, L., & Kovner, A. (2013). 101 careers in healthcare management. New York: Springer Pub. Hitchcock, D., & Willard, M. (2009). The business guide to sustainability: Practical strategies and tools for organizations (2nd ed.). London, England: Earthscan. Read More