Senior Director, Business Office (Project Management)

JOB SUMMARY:
The Senior Director of Business Office leads and optimizes all aspects of the business office operations, including coding, billing, cash posting, insurance follow-up, and denial management, ensuring financial performance, compliance, and operational efficiency. Specifically, the focus will be to maximize revenue, reimbursement, and collections through continuous improvement in communication, system and operation enhancement, and goal setting. The Senior Director of Business Office will work with an external coding company and collection vendors to ensure compliance and productivity goals are set to achieve organizational goals.

JOB SPECIFIC DUTIES AND RESPONSIBILITIES:
Lead and oversee the entire business office process, ensuring timely and accurate claims submission, payment posting, and revenue collection based on established goals.Manage the coding and billing teams to ensure compliance with healthcare regulations and accurate medical record documentation. Develop a departmental training tool and guide to ensure staff stays current with industry standards.Collaborate with vendors and internal coding team to resolve billing issues related to CPT, HCPCS, and ICD-10 coding issues.Provide and manage effective communication with all payers and the Revenue Cycle team for resolving claim disputes.Establish monthly meetings with payers to address claims issues and adjudication delays.Drive the resolution of rejected claims and coordinate underpayments to minimize delays in reimbursement.Oversee the insurance follow-up team to accelerate the resolution of outstanding claims.Responsible for the follow-up of billing and account management of denied/rejected claims. Monitor denied/rejected claims for trends and provide feedback to appropriate stakeholders to reduce the denied claims volume.Streamline cash posting and payment reconciliation processes to ensure accurate financial reporting.Develop and implement strategies to reduce accounts receivable days and optimize cash flow.Direct denial management efforts, identifying trends, and implementing corrective actions to minimize revenue loss. Prepare appeal letters and track the case until resolved.Oversee effective appeal processes and collaborate with payers to resolve claim disputes and ensure correct reimbursement. Escalate to the denial team any outstanding accounts that the insurance follow-up team is unable to resolve.Monitor key performance indicators (KPIs) related to aging accounts, denials, and payment cycles. Examples include analyzing and monitoring high-dollar accounts and accounts aged over 90 days in alignment with corporate financial goals through system reporting tools.Recruits, hires, and manages business office staff and evaluates performance to identify training opportunities, performance improvement plans, and merit increases.Maintains working knowledge of applicable laws and payer regulations and communicates changes to the business office staff for billing and follow-up teams. Ensure adherence to regulatory requirements, including HIPAA, CMS, and payer-specific guidelines.Identify and implement process improvements to enhance efficiency and accuracy in business office operations.Collaborate cross-functionally with finance, clinical, and operational teams to resolve business office issues.Regularly report on financial performance, providing actionable insights and recommendations to senior leadership.Perform other duties as assigned.

OTHER JOB REQUIREMENTS:
This individual must be able to work under pressure, while being proactive and resourceful. Confidentiality is crucial for this role. Expert verbal and written communication skills, strong decision-making ability, and attention to detail are equally important. This multi-tasker must be exceedingly well-organized, flexible, display a high level of professionalism, and enjoy the administrative challenges of supporting a clinic of diverse people and patients. Loyalty and respect for all physicians, patients, and co-workers are mandatory for this position.

SUPERVISORY RESPONSIBILITY:
Directs the activities of the Business Operations Department
Promote integration across areas and divisions, fostering collaboration.

EDUCATION, CERTIFICATION, LICENSURE, REGISTRATION:
Associates degree, required.Minimum ten (10) years of medical billing management experience, healthcare/clinic environment, required.Minimum four (4) years Revenue Cycle management experience required.

EXPERIENCE, SKILLS AND KNOWLEDGE:
Knowledge of organization policies and procedures.Knowledge in state and federal health care regulations and programs.Knowledge of records management, coding, managed care, and A/R policies and processes.Knowledge of fiscal management.Knowledge of billing and collections of various insurance payors.Knowledge of registration processes and impact on the revenue cycle.Skilled in exercising strong leadership, analytical, problem-solving skills, and the ability to meet deadlines.Skill in identifying and resolving problems.Ability to communicate fiscal policies effectively.Ability to establish and maintain effective working relationships with all stakeholders, including customers, co-workers, staff, and physicians.Ability to communicate effectively orally and in writing to customers, co-workers, staff, and physicians.

REASONING ABILITY:
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.Ability to interpret a variety of instructions furnished in written, oral, or schedule form.

INTERPERSONAL SKILLS:
Must interact and communicate both verbally and in written form.Must interact and exchange information regarding patients with physicians and other departmental personnel, and outside agencies on a frequent basis while respecting the confidentiality of patient information.

PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk or hear.The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT:
The work environment described here is representative of those employee encounters while performing the essential functions of this job.
This position involves potential exposure to infectious diseases. Colleagues are offered appropriate vaccinations and safety training.

DISCLOSURE:
This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of the 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. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.