Plans, organizes, controls, standardizes and directs and executes on revenue cycle management team strategy, operations and revenue cycle management activities for UH. The role provides leadership, direction, decision making, and supports management and staff in day to patient financial services activity including billing and collections, coordination with practices, department, Patient Access, coding, HIS and other areas as required to resolve patient and insurance claims. The role will work closely to support revenue cycle management corporate leadership to coordinate support and hand offs between departments and stakeholder to optimize patient experience and collections.
Routinely meets face to face with department staff, leaders, administrators and teams to ensure RCM operations, performance and metrics meet established goals. Sustains and drives team integration with RCM operations and UH enterprise culturally as well as through formal initiatives enabling integration and centralization of business functions to the RCM. The position is responsible for an estimated 120+ FTEs.
Establishes, enforces and ensures standards of performance and behaviors, monitors and analyzes departmental service standards for Billing, Insurance Follow up, Patient and Insurance collections, to ensure patients and providers receive superior service.
The position is responsible for adhering and creating Insurance and Patient Collection policy and guidelines in coordination with RCM leaders, as well as driving collection strategy, analysis, payment options, financial assistance as well as oversight of patient friendly billing, on line and other technology solutions as well as pre collect, collection and other vendors contracted to optimize patient collections. Ongoing alignment and strategy to coordinate and follow processes implemented by RCM.
Understands, remains current for self and ensure team is current with internal and external revenue cycle and system requirements and relationships including I.T., Legal, Compliance, Internal Audit as well as vendor relationships to ensure compliant revenue transactions.
• Directs department activities and ensures compliant services and operations including ensuring timely, accurate and patient friendly service including setting goals using industry benchmarks to drive best practice performance. Meets with leadership and staff weekly to ensure success department operations and help to resolve issues impeding performance.
• Implements and sustains routine auditing processes and reports findings as appropriate. Identifies billing errors, and follows-up with staff members/third party payors to ensure resolution reporting with feedback cycles are completed and documented to ensure ongoing improvement in service delivery.
• Develops, implements and publishes department score card capturing key performance indicators for each service line, provider groups and practices as appropriate, as well as vendor performance.
• Conducts analysis of department statistics, collections, agency performance and bad debt to identify ongoing service and collection strategies for the organization.
• Actively manages technology and vendor performance, outcomes and relationship ensuring expected outcomes are met and /or real time decisions to ensure best practice performance.
• Accomplishes human resource objectives by leading recruiting, selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining leaders and employees; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation actions; enforcing policies and procedures.
• Meets UH RCM insurance and patient collections financial objectives by forecasting requirements; preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions.
• Improves Insurance and patient collection quality results by studying, evaluating, and re-designing processes; establishing and communicating service metrics; monitoring and analyzing results; implementing changes.
• Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
• Works with leadership team to establish staff assessment, training and post training validation programs and ensures adherence requirements.
• Identifies opportunities for process improvement and automation by recognizing issues based on changes in patient inquiry trends. Provides timely feedback to peers in operational areas and leadership to improve Revenue cycle processes based on patient experiences. Participates in process improvement initiatives throughout the entire revenue cycle operation.
• Ensures staff members are properly addressing cases where patients needing services have no medical insurance (referred to as self-pay). Coordinates staff members and external agencies in assisting patients with obtaining coverage via government programs and the evaluation of charity assistance where applicable.
• Ensures staff members are properly handling all customer service/billing issues and questions, and works with priority patients, insurance companies and/or clinicians to ensure resolution.
• Ensures that self and department ensures in-depth knowledge of policies, procedures and laws relating to medical insurance/patient billing and collections.
• Ensures that self and department maintains in-depth knowledge of government assistance programs and resolves payment discrepancies that are escalated from the staff.
• Acts as Revenue Cycle leader and liaison to organization and vendors that interact with patients.
• Performs leadership evaluations and ensures standardization with the staff evaluation process.
• Performs other duties as assigned.Qualifications
• Bachelor’s Degree required in business, health administration, accounting and/or HIS
• Graduate degree preferred
Credentials, Licensure or Certification (i.e. RN, RRT):
Coding Certification preferred
Experience & Knowledge:
• 7-10 years management experience progressive experience in healthcare revenue cycle operations required including experience hiring, training, evaluating, disciplining, developing and engaging staff members.
• Minimum 2 years of ambulatory or practice management and/or hospital administration experience or equivalence.
• Experience with HIS, ancillary and practice management system navigation, dictionaries, controls and workflow.
• Experience tracking and analyzing call data and implementing process improvements required.
• Must be customer, provider, and employee focused with exceptional people and service skills
• Experience with managing escalated customer complaints, and executive level inquiries required.
• Must be detail-oriented and organized, with good analytical and problem solving ability.
• Notable client service, communication, presentation and relationship building skills required.
• Ability to function independently and as a team player in a fast-paced environment required.
• Must have exceptional written and verbal communication skills.
Special Skills & Equipment Knowledge:
• Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e., printers, copy machine, FAX machine, etc.) required.
• Oracle, Kronos, Soarian, CSC Papers, META, and/or IDX, experience preferred.