Job Description

Leadership Team Functions

• Identifies and address workflow inefficiencies and implements best practices to improve revenue cycle performance.
• Fosters a culture of continuous improvement and innovation.
• Acts as staff resource and role model for ethical, professional conduct.
• Participates in the hiring process.
• Delegates duties and projects to appropriate staff, and monitors for accurate and prompt completion.
• Stays apprised of all relevant regulations, standards, and directives from regulatory agencies and third- party payers.
• Stays apprised of changing healthcare trends and leverages technology and automation to develop and deliver new products and services to customers.
• Demonstrates knowledge of safety policies and procedures and actively maintains a safe and positive work environment.

Role Specific Functions

• Oversees all functions of the revenue cycle, including patient registration, charge capture, billing, collections, denials, and cash posting.
• Monitors daily operations and key performance indicators (KPIs) to ensure productivity, accuracy, and timely processing of claims.
• Ensures compliance with payer rules, HIPAA regulations, and federal/state billing laws.
• Collaborates with clinical, administrative, and IT teams to resolve billing or documentation discrepancies.
• Manages denial trends and coordinate appeals processes to minimize lost revenue.
• Analyzes revenue cycle data to identify trends, issues, and opportunities for improvement; prepare regular reports for leadership.
• Participates in payer contract reviews and fee schedule maintenance as needed.
• Supports audits, both internal and external, and ensure accurate recordkeeping and documentation.
• Leads and participate in system upgrades or software transitions related to revenue cycle systems (e.g., EMR/EHR, clearinghouses).

Knowledge, Skills and Abilities

• In-depth knowledge of coding (ICD-10, CPT, HCPCS), payer reimbursement rules, and medical billing regulations.
• Strong analytical skills with the ability to interpret and act on financial data.
• Experience with EMR/EHR systems and revenue cycle software (e.g., Epic, Cerner, Medent, Athena).
• Excellent leadership, organizational, and communication skills.
• Ability to work independently and collaboratively in a fast-paced environment.
• Exemplary problem-solving and conflict-resolution skills.
• Detail-oriented.
• Skilled in synthesizing a wealth of information
• Exhibits excellent time management and prioritization abilities.
• Capable of following and providing detailed instructions both orally and through written communication
• Extensive experience working with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Access, Project)

This position is hybrid and may require some onsite time.

 The above job description is not a contractual or binding document, nor does it alter the employment at-will status. It is provided as a guide to the types of essential duties required to be performed. Duties may vary from time to time and this description is subject to review. Modifications will be made as needed to support changes in business requirements. 

I have reviewed and understand the job description and believe it to be accurate and complete. I understand that Optimum Physician Alliance retains the right to change the Job Description, as they deem necessary. I will follow and adhere to my Job Description to the best of my ability.

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