POSITION

COMPETENCY REQUIREMENT

KEY RESPONSIBILITIES

No

1. Revenue and Assurance Director

EDUCATION AND EXPERIENCE

• He/she a Bachelor’s degree in Finance, Accounting, Business Administration, Business Information, Economics, Mathematics, statistics or a related field.
• A Master’s degree or professional certification (e.g., CPA, ACCA) is added advantage.
• 
  He/she must have Proven experience (5 years) in revenue assurance role, Finance, Accounting, Revenue cycle management, preferably in a managerial or supervisory role.

SKILLS AND ABILITIES

• Financial Acumen: Profound financial expertise with a keen understanding of revenue cycles, accounting principles, and financial analysis to identify revenue optimization opportunities and potential risks.
• Analytical Skills: Strong analytical capabilities to interpret complex financial data, perform trend analysis, and generate insights for revenue enhancement strategies and risk mitigation.
• Leadership and Management: Exceptional leadership abilities to manage a team, set goals, and guide them in executing revenue assurance initiatives effectively. Capable of fostering a collaborative work environment.
• Regulatory Compliance: In-depth knowledge of healthcare regulations, billing guidelines, and compliance standards (such as HIPAA) to ensure adherence and mitigate regulatory risks related to revenue operations.
• Problem-Solving: Advanced problem-solving skills to identify and address revenue leakage, billing inaccuracies, and process inefficiencies within the revenue cycle, devising effective solutions.
• Communication and Collaboration: Excellent interpersonal and communication skills to collaborate with cross-functional teams, convey complex financial information effectively, and liaise with internal and external stakeholders.
• Attention to Detail: Meticulous attention to detail when reviewing financial records, conducting audits, and implementing controls to ensure accuracy and integrity in revenue-related processes.
• Strategic Thinking: Ability to formulate and execute long-term revenue assurance strategies aligned with the hospitals financial objectives, driving continuous improvement and optimizing revenue streams.
• Technology Proficiency: Familiarity with financial software, data analysis tools, and ERP systems to facilitate financial reporting, analysis, and process optimization within the revenue cycle.

 Leadership and Team Management

• Lead, mentor, and manage the Patient Business Services unit, Billing and Recovery unit, and Revenue Assurance.
• Develop and maintain a high-performing team by setting clear goals, providing regular feedback, and fostering a culture of collaboration and accountability.
• Conduct performance evaluations, provide feedback, and support staff development and training initiatives.
• Provide ongoing coaching, mentorship, and performance evaluations to ensure staff effectiveness and productivity.
• Foster a collaborative and productive work environment.

Strategic Revenue Assurance

• Develop and implement a comprehensive revenue assurance strategy to maximize revenue while ensuring compliance with relevant regulations.
• Analyze revenue trends, identify potential revenue leakage points, and create strategies to address them.
• Collaborate with senior leadership to align revenue assurance efforts with the hospital's strategic goals.

Billing and Recovery Oversight

• Oversee the Billing and Recovery unit in managing billing processes, claims submission, and revenue recovery efforts.
• Ensure the timely and accurate submission of claims to insurance companies, government payers, and other third-party payers. Oversee the billing and timely submission of claims to insurance companies, government and private payers.
• Implement strategies to reduce denials and underpayments.
• Ensure all billing and coding practices adhere to relevant laws and regulations.
• Develop and implement strategies to optimize the hospital's revenue cycle, including reducing denials and improving collections.

Compliance and Regulatory Adherence

• Stay updated on healthcare regulations and payer requirements to ensure compliance with the hospital's billing practices.
• Collaborate with the Compliance department to develop and implement policies and procedures that adhere to regulatory standards.
• Conduct periodic audits to identify compliance issues and implement corrective actions.

Financial Analysis and Reporting

• Monitor and analyze key revenue performance indicators, such as accounts receivable, charge capture, and revenue recovery rates.
• Prepare and present regular reports to senior leadership, including the CFO, on revenue assurance performance and recommendations for improvement.

Process Optimization

• Identify opportunities to streamline and optimize revenue assurance processes for greater efficiency and accuracy.
• Collaborate with Information Technology to leverage technology solutions that enhance billing accuracy and reduce revenue leakage.
• Continuously assess and improve revenue cycle processes to enhance efficiency and accuracy, reducing denials and write-offs.
• Identify and implement technology solutions and software tools to streamline revenue cycle operations.
• Lead and develop quality improvement projects, policies, and procedure development and review.
• Identify areas where staff may require additional training or support for enhanced billing processes.

Patient Business Services Management

• Lead the Patient business services team to ensure smooth and efficient patient billing processes.
• Address patient inquiries and concerns related to billing and insurance matters.

Customers Management

• Oversee relationships with external customers and third-party partners involved in revenue cycle management.
• Evaluate customer performance and negotiate contracts to ensure cost-effectiveness and service quality.

Training and Development

• Develop and deliver training programs for staff in the Revenue Assurance, Billing and Recovery, and Patient Business Services units.
• Keep staff informed of industry trends, best practices, and regulatory changes.

Contract management

• Ensure that all partners have valid contracts.
• Ensure that expired contracts are renewed to the existing policies, laws, and regulations of the hospital.
• Lead the discussion with new partners.

Tariff management

• Lead the discussion for establishing and reviewing hospital tariffs for new and existing services.
• Ensure the accuracy and implementation of the hospital tariff.

Revenue Optimization and Analysis

• Analyze billing data to predict revenue streams and identify potential areas for revenue growth.
• Monitor and follow up on outstanding payments, devising strategies to minimize overdue accounts.
• Optimize cash flow by ensuring timely invoicing and efficient collection processes.
• Collaborate with finance departments to analyze billing data and contribute to financial planning strategies.