This position will provide coordination and subject matter expertise across all components of the revenue cycle for Hospital and Professional Billing Services to ensure streamlined, cost-effective, patient-centric operations for Renown Health facilities and affiliated entities. This position will implement initiatives and system efficiencies to optimize services and operations, as well as develop and implement new programs. This position will track and benchmark Revenue Cycle metrics for managed care and commercial financial classes against actual results while coordinating standard usage of all system reporting.
The Director of Managed Care Reimbursement will propose and implement programs, projects or procedures that may reduce risk, improve efficiency, decrease denials, increase cash collections, reduce accounts receivable, motivate staff or in general benefit of Hospital and Professional Billing Services and all of Revenue Cycle. Additionally, this position is responsible for tracking denial performance and implementing performance improvement initiatives for all payers.
Additional responsibilities include:
Responsibility for the strategic vision for Hospital and Professional Billing Services across for the Managed Care and Commercial Reimbursement teams, including but not limited to: cash goals, accounts receivable standards, denial prevention, and all applicable collection practices.
Ensures department goals for AR, cash collections, denial reduction, and employee retention are met, as well as ensures that subordinate staff are motivated and meet or exceed performance expectations.
Builds professional connections to maintain and improve payer relations and act as the main billing and follow up liaison for payers and other external contacts.
Leads monthly meetings with key internal stakeholders (e.g., physician group leadership, administrators, case management, etc.) to share critical information regarding denial performance trends for all payers and implement improvement initiatives; attends any required internal or external meetings to ensure ongoing success of denial reduction initiatives.
Develops and implements departmental procedures, standards, tools and techniques to effectively follow up on claims and maximize collections.
Analyzes and presents data to senior management members regarding cash collections, accounts receivable, denial management and employee productivity.
Coordinates and presents monthly performance reports to Financial leadership for month end.
Responsibility to plan, organize and implement process and business improvements on designated strategic initiatives.
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.
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.
Directs ongoing programs for staff development.
Develops and maintains excellent relationships with other internal and external departments.
This position does not provide patient care.