Medical Staff Credentialing Director jobs in Hillsboro, OR

The Staff Pad has partnered with the largest community-based behavioral health and substance use treatment services organization in the state of Oregon. Our client is a Certified Community Behavioral Health Center seeking a Sr. Director of Revenue Cycle to join their organization. 

Essential Duties

• Lead the Revenue Cycle Department
  
  • Optimize the structure of department’s workflow and staffing.
    
  • Responsible for account management, communications with insurance providers, collections, cash posting, contract analysis, and billing.
    
  • Efficiently manage patient complaints in respect of billing and collections.
    
  • Review and approve financial or medical hardship discounts / write-offs.
    
  • Develop policies and procedures across the department
    
• Ensure Effective Accounts Receivables (A/R) Performance
  
  • Ensure claims are submitted quickly, accurately and in a timely manner.
    
  • Ensure patients understand statements and pay outstanding balances.
    
  • Monitor A/R performance and monitor aging or uncollected balances.
    
  • Audit current procedures to monitor and improve efficiency of billing operations.
    
  • Oversee the coding and denial management processes
    
• Contract Management
  
  • • • Oversee the negotiation, creation, and management of contracts within the healthcare industry.
        
      • Ensure compliance with laws and regulations governing healthcare contracts.
        
      • Review and analyze contract terms and conditions.
        
      • Collaborate with internal departments to ensure contract terms meet organizational needs.
        
      • Monitor contract performance and compliance.
        
      • Keep abreast of changes in the healthcare industry that may impact on contracts.
        
    • Credentialing Oversight
      
      • Ensure compliance with regulatory and accreditation standards related to provider credentialing.
        
      • Collaborate with internal departments, such as People and Culture, to ensure provider credentialing requirements are met.
        
• Manage staff performance
  
  • Provide regular feedback, performance reviews, and one-on-one meetings.
    
  • Oversee the hiring and training of staff.
    
• Ensure Compliance to Applicable Rules and Regulations
  
  • Routinely monitor billing compliance by reviewing documentation, coding, and billing. This includes working with Information Technology (IT) and the providers to improve accurate charge capture when CID-10-CM and CPT/HCPCS codes are updated.
    
  • Work with the organization’s HIPAA Privacy/Security Officer to ensure new hire and annual training is conducted with your entire department workforce.
    
• Perform other job-related duties as assigned
  

Qualifications

Education:

Bachelor’s degree in finance, Business Administration, Healthcare Administration, or related field and certification in revenue cycle management specifically.

Experience:

Ten (10) years healthcare revenue cycle experience.

Proven leadership and customer service skills are also required for this position.

Experience with EPIC Electronic Health Record (EHR) system preferred.

Specialized Knowledge, Skills, and Abilities:

• Sound knowledge of health insurance programs and contracts
  
• Possess in-depth knowledge and understanding of Medicare, Medicaid, and Managed Care regulations.
  
• Proficiency in Excel including but not limited to Pivot Tables and Lookup functions
  
• Ability to adapt to changing technology
  
• Ability to read, interpret, research, explain and apply laws, rules, regulations, policies, and procedures related to program business
  
• Ability to prepare complex reports