Director of Revenue Cycle

Job Description

At CSI Pharmacy (CSI), we are on a mission to provide Specialty Pharmacy services to patients with chronic and rare illnesses in need of complex care. CSI is a rapidly growing national Specialty Pharmacy. Whether you work directly with patients or behind the scenes in support of the business and its employees, you will use your expertise, experience, and skills to support our patients and our mission.

Our Director of Revenue Cycle is a key member of the CSI Pharmacy Leadership Team. They are primarily responsible for ensuring compliant Billing, Collecting, and Reconciling Accounts Receivable. 

COMPENSATION: $130,000 to $140,000 Annual Salary + Annual Bonus Potential

Our high value rewards package:

• Up to 21 paid holiday and personal days off in year one
• 401k plan with matching contributions
• Industry-leading 360 You™ benefits program
• Up to 90% off higher education (degrees, certifications) and test preparation for you and your family through Purdue University Global Programs and Kaplan
• Car rental discounts through Enterprise
• Employee Assistance Program (EAP) offered through Lincoln Financial Group
• NOTE:Certain benefits may vary based on your employment status

What you’ll do in this role:

• Develop, implement, and update Standard Operating Procedures for all Revenue Cycle functions.
  
• Oversee Billing Department functions, ensuring accurate and timely Claims Processing for services provided, including Unbilled Aging, Clean Claim Monitoring, and Compliant Claim Submissions.
  
• Continually monitor Accounts Receivable, ensuring timely and effective follow-up and resolution.
  
• Oversee the Cash Posting Process, ensuring cash is posted correctly and recoupments are documented and transferred promptly.  
  
• Ensure that refunds due to payers or patients are addressed promptly.
  
• Develop goals and measurable metrics for the team regarding Claims Billed, Cash Collected, and Cash Posted.
• Oversight of Audit Processes for all departments, monitoring effectiveness and outcomes.
  
• Responsible for ensuring Payer/Pricing/Per Diem set-ups in Caretend are fully utilized and accurate.
  
• Final review and approval of SOX Reports.
  
• Monitor the timeliness and effectiveness of department activities, ensuring that outstanding Patient Accounts and Accounts Receivable are controlled, and that bad debt is within the budgeted target.
  
• Work with Insurance and Authorization on problems identified as a result of verification errors to improve processes upfront.
  
• Evaluate accounts for write-offs and identify improvement opportunities to reduce future write-offs.
  
• Compile monthly Revenue Cycle Billing statistics, including but not limited to time to Bill, Clean Claim Processing, Employee Productivity, and A/R Analysis.
  
• Develop and monitor adherence to appropriate departmental productivity metrics.
  
• Establishes, monitors, and reports to leadership appropriate Specialty Pharmacy Revenue Cycle KPIs monthly with a quarterly enhancement.
  
• Maintain statistical reports or spreadsheets on the providers to assist Billing and Authorization.
  
• Implements and monitors appropriate internal controls as they relate to the Revenue Cycle function.
  
• Serves as a liaison to Clinical Operations Teams to achieve and maintain operational efficiencies related to reduced days sales outstanding and write-offs.
  
• Communicates with Benefit Verification/Authorization teams on improvements and areas of need to streamline operations in all functional areas.
  
• Maintain a system of communication with the Finance Department.
  
• Works in conjunction with the contracting function regarding re-credentialing, securing new payor contracts, or terminating/negotiating unfavorable low-dollar contracts.
  
• Maintain and oversee all relevant tracking systems and maximize the use of available technology.
  
• Responsible for oversight and overall development of the Revenue Cycle Teams.
  
• Manage members of the team, assign job duties, conduct performance reviews, and implement disciplinary actions.
  
• Conduct interviews and develop procedures to train new-hire employees and retain current staff.
  
  

We are looking for a Pharmacy Scheduler with:

• Bachelor’s Degree in Health Care Administration or Business-related field or relevant experience.
  
• Provide the highest level of professionalism, responsiveness, and communication to build and maintain the maximum customer base possible.
  
• Must possess the ability to multi-task and frequently change direction.
  
• 8 plus years of Healthcare Revenue Cycle leadership experience (Specialty Pharmacy experience preferred).
  
• Experience with Caretend EMR software a PLUS.
  
  

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

By supplying your phone number, you agree to receive communication via phone or text.

By submitting your application, you are confirming that you are legally authorized to work in the United States.

JR# JR246846