This position will provide coordination and subject matter expertise across all components of the revenue cycle for Health Services to ensure streamlined, cost-effective, patient-centric operations at the medical groups and affiliated entities. This position will make recommendations for improvement and initiatives to develop and implement new programs, system efficiencies and optimizations to improve services and operations. This position will track and benchmark Revenue Cycle metrics for Health Services against actual results while coordinating standard usage of all system reporting. Develop and make recommendations in the creation of capital and operating budgets. Present a business case to Chief Financial Officer regarding programs, projects or procedures that may reduce risk, improve efficiency, increase cash collections, reduce accounts receivable, motivate staff or in general benefit of the Professional Billing Department and all of Revenue Cycle. In addition, will have direct responsibility to plan, organize and implement process and business improvements on designated strategic initiatives.
Additional responsibilities include:
Expert knowledge of coding and billing guidelines and policies to provide education, development, and monitoring.
Ensure compliance with relevant regulations, standards and directives from regulatory agencies and third party payers.
The position will ensure that appropriate internal control safeguards are maintained for provider credentialing, professional coding, health system billing, cash collections, accounts receivable records, and self-pay processes.
Develops implements and presents business operations and financial planning policies and procedures throughout revenue cycle.
Monitors and maximizes reimbursement through denial prevention and accounts receivable management.
Develops and implements departmental procedures, standards, tools and techniques to effectively process claims and maximize collections.
Coordinates with Information Resources in the development, evaluation and maintenance of information systems for electronic billings, electronic remittances, payer reimbursement, payer confirmation of claims, denial management, corporate compliance and collections to maximize reimbursement, provide peak performance and reporting.
Participates as a member of the subcommittee of the Corporate Compliance Committee. Supports the corporate compliance efforts through investigation, policy/procedure development and monitoring.
Provides vendor contract management and monitoring to ensure performance and productivity for Professional Billing Services.
Analyzes and presents data to the Chief Financial Officer and other senior management members regarding cash collections, accounts receivable, denial management and employee productivity.
This position is responsible for collaborating with operational leaders to provide timely accurate financial information with a focus on, results compared to stated goals, reduction in denied services and areas of opportunity.
The position will collaborate with inter-departmental teams to strengthen relationships with physicians and internal and external departments.
Develops the budget for the assigned departments, allocating funds within budget limits to accomplish departmental and health network objectives and goals. Monitors variances against budget on an on-going basis. Ensures accurate daily/monthly statistical and financial reports are compiled and necessary.
This position provides mentorship and development of staff to lead and engaged team.
This position does not provide patient care.