Director of Revenue Cycle

Description

Job Description 

Job Title:   Revenue Cycle Manager  Employment Status:  Salary (Exempt) 

Department:  Finance Reports To: Chief Financial Officer 

MISSION STATEMENT: Leading adolescents to a new legacy. 

The mission of CLEARFORK ACADEMY is to offer the highest quality and professional, substance abuse and mental health treatment across a full continuum of care.  

We are committed to treating patients and their families with the highest regard and respect as clients work toward reaching their highest growth potential in their recovery process. This is accomplished through the strict adherence to the highest ethical standards of care and policies and procedures set forth by the Texas Department of State of Health Services and the Joint Commission. 

• CLEARFORK ACADEMY ensures all clients are treated with compassion, respect, and dignity regardless of race, creed, age, sex, handicaps, or sexual orientation. 
• CLEARFORK ACADEMY employees are competent and responsible personnel who adhere to a strict code of professional ethics which include but are not limited to the prohibition of fraternization with patients, exploitation of clients, or any criminal behaviors. 
• CLEARFORK ACADEMY provides clients with accurate and complete information regarding the available services including the program rules, regulations, goals, and objectives of the program. 
• Appropriate availability of alternative treatment modalities is made at any time before during or after treatment if they are requested or the client’s needs are out of the scope of our practice. 
• CLEARFORK ACADEMY will ensure that discharge from treatment is conducted in accordance with Texas rule standards. 
• CLEARFORK ACADEMY provides both Texas and Joint Commission environment of care standards.  
• CLEARFORK ACADEMY will take all necessary and appropriate measures to maintain individual client records and information in a confidential and professional manner. 
• CLEARFORK ACADEMY strives to maintain positive relations with the surrounding community and pursues every reasonable action to encourage responsible client behaviors and community safety.  

SUMMARY 

The Revenue & Billing Manager at CLEARFORK ACADEMY is responsible for the design, implementation, and execution of the entire billing process beginning with verification of benefits and ending with payment collection and claim close out. The Revenue & Billing Manager generates revenue for Clearfork Academy by making payment arrangements. This is accomplished through collecting accounts, monitoring, and pursuing delinquent accounts as well as completing claim follow up and dispute resolution with insurance companies on both an in-network and out of network basis, as well as with private pay clients. This position requires the ability to produce and present financial billing reports at regular intervals. 

AGE/PATIENT POPULATION(S) SERVED 

Age of Patient Population Served:  Adolescent and Young Adult Males & Females  

Population Served:  Persons meeting DSM 5 criteria for substance use disorders with or without co-occurring psychiatric illness. 

ESSENTIAL DUTIES AND RESPONSIBILITIES 

• Protects facilities’ value by keeping collection information confidential and maintaining patient confidentiality. (HIPPA Compliant & Trained) 
• Confirms eligibility and benefits verifications for treatment at all facilities. 
• Inputs the correct billing codes for services rendered and uses those codes to bill insurance providers. 
• Preparing, reviewing, and transmitting claims using electronic billing software. 
• Identifies and bills secondary and tertiary insurances for eligible clients. 
• Follows up on unpaid claims within standard 60-day billing cycle timeframe. 
• Analyzes Explanation of Benefits (EOB) forms to ensure insurance companies have paid correctly for billed charges. 
• Review client bills for accuracy and completeness and obtaining any missing information. 
• Calls insurance companies regarding any discrepancy in payments if necessary. 
• Research and appeal denied claims. 
• Collects delinquent accounts by establishing payment arrangements with clients; monitoring payments; following up with clients when payment lapses occur. 
• Utilizes collection agencies and small claims court to collect accounts by evaluating and selecting collection agencies; determining appropriateness of pursuing legal remedies; testifying for the facility in court cases. 
• Reviews accounts for insurance or patient follow-up. 
• Answers all client or insurance telephone inquiries pertaining to assigned accounts. 
• Updates billing software with rate changes. 
• Updates cash spreadsheets, running collection reports, and providing month end reporting of billing department information including KPIs. 
• Develop and implement quality assurance for all billing and collection core processes for special program and implementation for all levels of care provided under the Clearfork Academy umbrella of services. 
• Audits charts and accounts for financials, correct insurance policy information, financial agreements, invoices, etc.  
• Coordinate with all other departments to assure that billing is being reported in an accurate and timely fashion. 
• Personnel development through the hosting of L10 department staff meetings. 
• Submits contracts for credentialing, with follow ups. 
• Creates single case agreements with providers for specifics plans that do not have out of network benefits.  
• Update all payers quarterly with required information to stay enrolled in EFT’s, claim status and any other communications 
• Other duties and tasks as assigned. 

AGE SPECIFIC COMPETENCIES (ADOLESCENT AND YOUNG ADULT MALES)  

• Allows patient to maintain control; involves patient in decision-making and planning of care, as appropriate to condition and situation. 
• Encourages participation in care. 
• Demonstrates clinical knowledge of expected vital signs. 
• Identifies trauma, abuse/neglect or exploitation a client may have experienced. 
• Encourages family support. 
• Recognizes/respects concerns over interruption of work/plans/separation from family, etc. 
• Recognizes fears regarding potential lifestyle changes. 
• Encourages verbalization of fears and anxiety; maintains age-appropriate communication. 
• Demonstrates an understanding of developmental milestones of adolescents and young adult. 

MINIMUM JOB REQUIREMENTS 

Education, Training, and Experience Required: 

• Bachelor’s Degree in related field of study (preferred) 
• 2 to 5 years work experience as an Admission/Intake Specialist or Billing Specialist, preferably in the field of chemical dependency and/or behavioral health. 
• Current CPR/FA certification 
• Current Handle with Care Physical Holding Certification 

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES 

• Knowledge of industry standards: organization, theory, principles, and research processes, accreditation and regulatory standards, ability to assess clinical care requirements based on psychotherapeutic and human development principles, scope of practice, and regulatory standards. 
• Knowledge of legal and ethical issues related to patient’s rights. 
• Knowledge of crisis intervention techniques. 
• Knowledge of community/regional mental health resources. 
• Knowledge of principles and practices of customer service. 
• Professional readiness: Issues related to self-awareness, diversity, ethics, and continuing education 
• Knowledge of PC and Mac software programs, particularly Microsoft Word and Excel is required. 
• Written and oral communication skills; must be able to concentrate on work amid distractions such as noise, conversations, and foot traffic 
• Must maintain self-control in volatile or hostile situations such as when verbally or physically confronted in an aggressive manner 
• Must be able to work independently with little direct supervision in an unstructured environment with multiple demands 
• Reading and writing level that can clearly express or understand complex concepts, assessments, directions and processes or sequences of events - level equivalent to at least two years of college. 
• Ability to represent the program well in interactions both inside and outside the facility 
• Demonstrates an understanding of the developmental milestones of adolescents and young adults. 

PHYSICAL DEMANDS/WORKING CONDITIONS:  

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

While performing the duties of this job, the employee is occasionally required to stand or sit for extended periods of time. The employee must occasionally lift and/or move up to 25 pounds. 

The job requires frequent contact with water (hand washing and cleaning) and working with body fluid and hazardous chemicals. When under these working conditions, OSHA standards and universal precautions must be followed at all times. 

While performing the duties of this job, the employee must be able to work in a fast-paced environment with minimal to high volumes of stress. 

EEOC STATEMENT: 

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or