Azul Vision is the largest eye care practice in Orange County, Inland Empire, and the Los Angeles area, with Twenty-Five locations and our newest location is Palm Desert to serve you conveniently and comfortably. Our world-class eye doctors are experts in all aspects of eye care as well as leading specialists in vision correction, cataract surgery, and laser eye surgery. We offer everything from cataract removal to cosmetic procedures such as eyelid surgery. You can rest assured you will receive cutting-edge treatment in a comfortable, friendly, and high-tech environment.

The Director, Revenue Cycle is responsible for maximizing revenue across the entire organization ensuring all services are billed to the optimal risk bearing entity with the proper backup to support payment of the charge.

RESPONSIBILITIES:

• Reviews and enhances insurance verification, coding review, billing, collection, and payment posting processes and procedures for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current workflow
• Establishes productivity standards, goal and priorities; ensures days to bill, days in accounts receivables and uncollectable charges/adjustments are within established departmental goals.
• Ensures all work performed is billed in a timely manor including diagnostic services and services performed outside of owned locations such as surgery centers or other per diem work.
• Works with clinic management to obtain missing information in a timely manor.
• Ensure charges are coded appropriately based on industry standards including proper coding to achieve Prop 56 credits for Medi-Cal patients. This also includes ensuring all drug injection codes also have drugs billed and vice versa as well as ensuring E&M codes are billed when appropriate.
• Ensures accurate billing of copay and coinsurance charges to minimize open self-pay balances as well as reduce patient refunds and credits. Support the patient copay assistance programs.
• Ensures charges accurately reflect the correct rendering and billing physician along with the correct location. Ensures ancillary services are posted in a method to easily track productivity.
• Monitors daily productions of claims, denials, and appeals and track problematic trends
• Assist with the calculation of staff incentives related to productivity and clinic performance.
• Monitor billing tendencies to ensure utilization is within reasonable industry expectation. This includes proper use of Modifier 25.
• Maintains appropriate internal control safeguards over AR records and collection of cash.
• Ensures accurate classification of patients and services as capitated vs fee for service.
• Works closely with the Finance team to ensure the PM system and Accounting system revenue remains in balance.
• Provide oversight pertaining to patient billing, communications with health insurance, collections, cash posting, contract analysis, credentialing, authorization, eligibility, denials, appeals and copay/coinsurance charges.
• Identifies services, charges, and billing methodologies that detract from the maximization of revenue reimbursement and takes steps to correct.
• Researches and reconciles unapplied or misapplied payments and credit balances.
• Coordinates revenue management orientation and educational activities of clinical personnel including providers, management, and staff about coding and other outstanding revenue cycle issues.
• Works closely with optical leadership to ensure optical sales and material costs are properly accounted for including back charges for external lab fees.
• Reviews, monitors, and recommends updates to the Clinics fee schedule to maintain fees at levels that maximize reimbursement; supports in payer rate negotiations.
• Leads the onboarding efforts of newly acquired clinics into the companies practice management systems.
• Maintains current knowledge of relevant insurance coding and reimbursement issues

REQUIREMENT:

• Full COVID-19 vaccination is an essential requirement of this role. Azul Vision will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
• Azul Vision requires all new hires and employees to report their COVID-19 vaccination status
• Employees must comply with any state and local masking orders. In addition, when in an Azul building, employees are required to wear a face mask at all times.
• Or an approved exemption