Key metrics include Days in Accounts Receivable (DAR), denial rates, clean claim rates, and collection rates. DAR measures efficiency in collecting payments, while denial rates highlight areas needing process improvement. Clean claim rates reflect billing accuracy, reducing rework. Collection rates gauge overall financial health. Tracking these ensures timely revenue capture, identifies bottlenecks, and supports data-driven decisions to optimize revenue cycle operations.

First, I’d analyze denial trends by payer, reason, and department to pinpoint root causes, such as coding errors or missing documentation. Next, I’d collaborate with billing, coding, and clinical teams to implement corrective actions, like staff training or process adjustments. Concurrently, I’d monitor denial rates post-intervention to measure effectiveness. Proactive denial management minimizes revenue leakage and improves cash flow.

I stay updated on regulatory changes through industry publications, webinars, and professional networks. I conduct regular audits to ensure adherence to guidelines like HIPAA and CMS requirements. Training sessions are organized for staff to align workflows with new rules. By fostering a culture of compliance and leveraging technology for real-time updates, I mitigate risks of non-compliance and associated financial penalties.

I utilize EHR and RCM systems to automate claims submission, track denials, and generate performance reports. Predictive analytics identify patterns, enabling proactive interventions. Tools like AI-powered coding assistants reduce errors. Integrating these technologies streamlines workflows, enhances accuracy, and accelerates reimbursement, ultimately boosting revenue cycle performance.

At my last role, I identified high denial rates due to incomplete documentation. I initiated a cross-departmental training program for clinicians on proper documentation practices and implemented a pre-submission claim scrubber. Within three months, denials dropped by 25%, and clean claim rates improved by 15%, significantly enhancing revenue capture and operational efficiency.