The Director will be an advisor to the Health System EVP and CFO and other Leadership on present day and future opportunities to maximize reimbursement. A strong communicator who will actively be engaged with Clinical operations to improve revenue capture and reimbursement.
The Director will provide leadership and oversight for revenue integrity including reimbursement practices, policies, procedures, programs and systems to ensure effective revenue capture and reimbursement processes across the system. In addition, have command of Medicare and other governmental regulations related to reimbursement across the system.
Associate’s Degree in Business related field and a minimum of seven (7) years healthcare patient accounting experience OR;
Bachelor's degree in Nursing, RHIA, Business or Healthcare Administration, preferred; or equivalent management background experience.
Progressive experience in and in depth knowledge of the health care field, required.
Hands-on experience with Meditech or other hospital billing software applications, required.
Previous experience in hospital revenue and reimbursement activities, preferred.
Extensive experience with charge master management and medical billing/coding systems (i.e., Uniform Billing Revenue Codes, CPT/HCPCS, ICD 9/10 required; CPC or CPC-H coding certification, preferred.
NOTE: An equivalent combination of education and experience may be considered.
Knowledgeable of standard methodologies, tools, software related to project development (such as Microsoft Project, Microsoft Excel) and revenue cycle metrics, preferred.
Ability to analyze revenue cycle performance and identify needs for process improvement in revenue cycle operations including charge capture, billing and accounts receivable follow-up issues, billing edits, bad debt, denials and regulatory compliance.
Project management skills required, coupled with a detailed knowledge of financial metrics and the ability to develop project plans, establish and implement revenue cycle goals, and manage multiple projects with innovation, creativity, and vision.
Ability to create and interpret statistical control charts, Pareto charts, tracking systems, and dashboards utilizing decision support techniques and effectively communicate findings.
Ability to utilize RAC and other payor process knowledge and software to track and appeal recoupments.
Ability to collaborate with administration, physicians, auditors, clinical and financial departments to ensure effective and efficient processes for optimal revenue cycle outcomes.
Uses knowledge of healthcare payer requirements for revenue capture and revenue cycle financial indicator performance improvement.
A thorough knowledge of health care revenue generation and reimbursement principles for hospitals, long-term care facilities and physician practices including applicable governmental regulatory and other payor requirements including managed care practices and policies.
Substantial analytical skills and the ability to communicate effectively in both oral and written forms, required.
Must possess the ability to manage complex projects requiring judgement to identify and analyze problems.
Must possess the ability to perform all duties independently.
Must be able to prioritize work and meet all deadlines.
Must be able to coordinate and direct the work of other staff on a collaborative basis without direct supervisory authority.
Extensive use of personal computer applications is required, as well as use of copier, fax and other standard office equipment.
Demonstrated commitment to the Health System’s mission, vision, and values.
Physical Requirements: Light-Medium Physical Agility Test (PAT) Rating
While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert 15 to 20 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or 5 to 10 pounds of force frequently, and/or greater than negligible up to 5 pounds of force constantly to move objects.
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.