Billing & Revenue Integrity Director

Administration
6210 US-290 E
Austin, TX 78723, USA

ABOUT AUSTIN REGIONAL CLINIC

Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 15 years! We are one of central Texas’ largest professional medical groups with 35+ locations and we are continuing to grow. We offer the following benefits to eligible team members:
Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more. For additional information visit

PURPOSE

The Billing & Revenue Integrity Director is responsible for ensuring that patient encounters are accurately and completely translated into clean claims for timely submission to payers. This position provides leadership and oversight for billing operations and revenue integrity activities. The Director is responsible for the Professional Billing (PB) and Revenue Integrity processes which includes a focus on charges, reducing billing errors, and improving daily revenue flow for clinician services.

Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

ESSENTIAL FUNCTIONS

• Directs the organization’s Professional Billing and Revenue Integrity functions.
• Provides leadership and oversight for all operational workflows required to move completed patient encounters to accurate initial claim submission.
• Oversees Billing & Revenue Integrity operations through direct supervision of managers and supervisors. Holds managers and their staff accountable for achieving stated objectives.
• Works effectively with leaders to develop and implement consistent, sustainable business processes.
• Through the managers ensures competency of staff through development and regular evaluations.
• Ensures claims are generated and submitted accurately, completely, and timely in accordance with organization standards and payer requirements.
• Monitors encounters that have not progressed to billing and ensures appropriate follow-up and resolution.
• Establishes clear accountability for unresolved encounters, billing holds, edits, and work queues.
• Maintains appropriate controls to prevent encounters from remaining unbilled or unresolved beyond established thresholds.
• Ensures appropriate escalation processes exist for complex or aging billing issues.
• Oversees charge review work queues designed to identify incomplete, inconsistent, missing, duplicate, or potentially inaccurate charges before claim submission.
• Establishes standardized processes for researching and resolving charge review edits.
• Oversees reconciliation processes designed to identify encounters, procedures, supplies, medications, diagnostic services, or other billable activity that many have not been appropriately captured.
• Assists the organization in denial management by analyzing root causes for rejected and denied insurance claims to propose process improvements.
• Develops full-scale project plans and related communication documents, project post mortems, and creates a recommendations report in order to identify successful and unsuccessful project elements.
• Develops best practices and tools for project execution and management.
• Responsible for the implementation of department-specific goals and objectives consistent with the organization’s strategic plan and goals and industry benchmarks.
• Collaborates with departments throughout the company to streamline procedures related to the revenue cycle process to achieve the effectiveness, efficiency, compliance and accuracy of the billing effort.
• Communicates regularly with others about department progress toward goal achievement, critical factors, and obstacles.
• Sets and continually manages department expectations with team members and other teams.
• Determines the frequency and content of status reports from the department, analyzes results, and troubleshoots problem areas.
• Participates in system upgrade planning and implementation.
• Coordinates resources with other teams and departments in the organization.
• Leads and/or attends meetings, participates in…