Director of Utilization Review & Revenue Cylce

Cumberland Heights

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Job Summary

The Director of Utilization Review and Revenue Cycle supports Cumberland Heights’ mission of providing the highest quality care possible in a cost-effective manner for persons and families who are at risk for or who are suffering from the disease of chemical dependency.  Treatment encompasses the physical, mental, emotional and spiritual dimensions of recovery by offering a safe, loving and healing environment, combining professional excellence and the principles of the Twelve Steps.

POSITION SUMMARY

The Director of Utilization Review and Revenue Cycle is responsible for all aspects of the utilization management function for clinical services, including internal and external review processes and the entire revenue cycle.  This position negotiates contractual arrangements with insurance companies and ensures the collection of fees from individuals.  The Director also is responsible for the recording of revenue and the reporting of A/R activities to executive management.  This position works closely with most departments within the organization.  This position reports directly to the Chief Financial Officer

Job Responsibilities

PRIMARY DUTIES AND RESPONSIBILITIES include the following:

1. Manages and oversees the work of the Patient Accounting/Accounts Receivable department and Utilization Review department coordinators.
2. Maintains the integrity of the Accounts Receivable computer system and provides regular reports and ad hoc information.
3. Works directly with the collection of major problem accounts.
4. Negotiates contracts and fee schedules with insurance companies.
5. Manages, designs, evaluates and implements the Accounts Receivable collection process.
6. Maintains internal controls with regard to funds collected.
7. Monitors credit policy and approves exceptions for both individuals and insurance companies.
8. Constructs monthly operating reports for assigned area.
9. Ensures that a welcoming, safe and healing environment is maintained for each patient and family throughout the continuum of care.
10. Recommends ways to improve the quality and delivery of services.
11. Ensures proper handling and distribution of company funds.
12. Maintains confidentiality of company and patient information.
13. In conjunction with the Chief Financial Officer, develops, implements, supervises, and evaluates a comprehensive utilization review and management process for the organization’s clinical services, including

1. Serving as the organization’s internal consultant for utilization management;
2. Serving as the contact for various managed care organization’s utilization review staff/supervisory personnel, working closely with executive management as needed;
3. Monitoring and reporting on credentialing and standards changes, as well as trends among managed care organizations; and
4. Performs all the duties of a Utilization Review Specialist as needed.

14. Develops and implements policies and procedures for assigned areas.
15. Subject to executive approval, develops the annual budget for the department and manages the financial resources of the assigned area.
16. Manages and participates in a variety of quality improvement activities, including, but not limited to, administrative committees, work groups/task forces, internal and external customer complaints, data collection and trend reporting, etc.
17. Reacts productively to change.
18. Performs other duties as assigned.

 

SUPERVISORY RESPONSIBILITIES

Supervises Utilization Review and Patient Accounting department coordinators. Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws.  Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Qualifications

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skills and/or abilities required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.      

EDUCATION AND/OR EXPERIENCE

Bachelor’s degree /Masters Preferred in related field is required; a minimum of five (5) years’ experience in a related area, five (5) of which are in healthcare receivables management required; two years of utilization review/management experience required and/or equivalent education or experience in job related activities.

OTHER SKILLS

Ability to lift up to 20 pounds; ability to speak, hear, see, sit and reach; ability to speak, read and write in English; good problem solving skills; excellent analytical skills; good interpersonal skills; good written and oral communication skills; excellent customer service skills; excellent negotiation skills; organizational skills for managing and prioritizing multiple tasks and assignments; good supervisory and motivational skills; attention to detail; excels in Microsoft Word, Outlook, and Excel; ability to learn Medhost and Sunwave patient accounting software. If recovering, two years of verifiable abstinence required with five years preferred; active participation in the appropriate Twelve Step program preferred.

WORK ENVIRONMENT

Position is in an office setting that involves everyday risks or discomforts requiring normal safety precautions. Position may involve local travel. Position is subject to long hours.

Additional Information

Benefits

How to Apply

Please go to our website @ Cumberlandheights.org

Details

• Date Posted: October 7, 2020
• Type: Full-Time
• Job Function: Accounting / Financial Management
• Service Area: Health (Physical, Mental)