Under the general direction of, and guidance from, the Senior Director of Revenue Integrity and Physician Revenue Cycle, the Director of Middle Revenue Cycle is responsible to oversee both hospital charging and billing practices to promote compliant, efficient charge capture, charge reconciliation, and claim submission to BMC payers, accurate posting of payments and managing refunds and credits. The Director will be responsible for creating programs that define and execute quality, efficient, and effective standards for revenue cycle and complementary functions.
ESSENTIAL RESPONSIBILITIES / DUTIES:
Revenue Cycle Management
- Directs, through managerial personnel, the activities of the Patient Financial Services and Revenue Charge Systems Departments to ensure operational excellence and delivery of quality patient-focused services in accordance with applicable policies, procedures and professional standards.
- Provides vision and leadership expertise in guiding the complete process re-engineering of middle revenue cycle as assigned
- Oversees the functions of the cash processing, refunds and credits for BMC and BUMG to ensure accuracy and timeliness of all transactions.
- Is responsible for leading the daily billing cycle for all BMC payers, ensuring revenue/charging processes are appropriate and maximized for the benefit of BMC
- Oversees activities to ensure goals and objectives are met by specified target dates.
- Monitors the weekly bill edit reports to ensure timely billing and identifies problem accounts that need resolution
- Works with each Team Leader to ensure that all third party payers are not holding accounts in the systems to miss the appropriate payment time lines.
- Manages business relationships with outside entities, including MassHealth operations, BMCHP, Healthcare Financial, Inc., Change Healthcare Associates, Mass Hospital Association and others.
- Assists Management Team with evaluating and implementing new processes to accommodate for the ongoing changes associated with Massachusetts Health Care Reform. This includes, but is not limited to, training of employees, restructuring Work Quality Monitors, identifying new report requirements, system adaptations, and work flows to assure efficient compliance.
- Represents the department at meetings and on committees participates in the decision and policy-making process on hospital-wide issues, particularly those which relate to billing, as assigned.
- Develops standard metrics and routinely communicates performance on those metrics to senior management. The financial measurements/indicators shall illustrate the positive and negative trends of the work.
- Leads an on-going review process of the negative trends and investigates the root cause of these trends. Recommends actions for corrections. Meets managers on a routine basis to implement and streamline business processes to improve the middle revenue cycle.
- Leads the enhancement of existing revenue cycle systems or business processes, with the focus being to gain efficiencies and improve revenue collections for the hospital. This includes working closely with teams and senior leaders to enhance and /or eliminate unnecessary manual processes.
- Is overall responsible for the middle revenue cycle management audits. This includes gathering and providing the required documentations to the auditors.
- Works with BMC departments to develop and implement automated systems to streamline infrastructure and improve billing service for all clinical areas
- Consistently demonstrates tact, courtesy and a positive attitude in communication and interaction with other employees, third-party payer representatives, physicians and patients. At all times presents the department and the hospital in a positive manner
Daily Department Management
- Responsible for effective fiscal management of departmental operations to ensure proper utilization of departmental financial resources; develops the departmental budget and manages to budget.
- Works with other BMC leaders to provide continuous training to the all users, department directors and managers to ensure systems utilization is at maximum capability.
- Enhances operational protocols and use statistics/metrics to determine overall performance and effectiveness, team performance and error rates, deficits in systems, etc. Communicates those metrics to the Senior Directors and VP of Revenue Cycle
- Ensures an effective quality assurance program.
- Ensures departments maintain effective and appropriate staffing by monitoring employee turnover, overtime and absenteeism.
- Selects qualified Managers for employment. Ensures Managers set their own achievable goals within guidelines established by Director. Conducts effective annual performance appraisals of Managers.
- Assists managers in the development of specific goals and action plans for their areas and reviews such goals on a monthly basis.
- Responsible for all communication within designated areas as well as throughout the organization to ensure that information is shared for effective operations.
- Participates in employee disciplinary procedures, following Human Resources guidelines as required.
- Required to meet with BMC Department Administrative Directors regularly to build consensus on strategy; rewrite departmental procedures as a result of changes, and provide statistics on quality, service and financial performance
- Reviews, updates and implements policies and procedures as it relates to the functions of the middle revenue cycle processes
- Actively involved in activities to ensure patient and employee satisfaction.
- Engineers and maintains a Middle Revenue model that supports BMC and clinical operations
- Creates and promotes a customer service-oriented work environment
- Develops new and innovative technology infrastructure to establish and support a high functioning role.
- Ensures department adapts to regulatory changes in a timely manner.
- Leads response to applicable audits by governmental or third party payers.
- Is an active member of the denials and other committees and takes responsibility for generating action plans to increase a better functioning revenue cycle.
- Responsible for departmental planning consistent with hospital's mission and goals.
- Develops and reviews annually short and long-term goals and objectives.
Human Resources Management
- Institutes applicable training; initiates updated job requirements/descriptions for all staff; mandatory training, certification, and continual quality audits, e.g. Performance standards
- Conducts routine department and staff meetings
- Oversees activities to ensure goals and objectives of the organization are met by specified target dates
- Creates and fosters a work environment that encourages productivity and work loyalty and employee satisfaction.
- Conducts performance appraisals for direct report staff and ensures all performance appraisals in department are completed timely.
- Maintains appropriate staffing levels by planning and working closely with recruiters in Human Resources and the Revenue Cycle Human Resources Business Partner
- Ensures proper employee orientation, supervision and productivity monitoring
- Administers coaching and disciplinary measures as needed
- Evaluates opportunities to automate work functions to reduce cost of doing business associated with labor costs.
Meets hospital-wide standards in the following areas:
- Conforms to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care may be provided.
- Utilizes hospital's Values as the basis for decision-making and to facilitate the hospital mission.
- Follows established hospital infection control and safety procedures
- Develops competencies as related to position.
- Performs other tasks as needed.
Bachelor's Degree in Finance or Business or Financial Management or related field required, Master's Degree preferred
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
Minimum of 7-10 years related management experience required. Specifically, experience in an academic medical center managing hospital charging and billing functions preferred. Demonstrated leadership experience in the medical field required.
KNOWLEDGE AND SKILLS:
Proven track record of success in improving revenue cycle performance and customer service. Demonstrates ability with computer and Microsoft tools. Work requires the ability to develop policies, procedures, processes and programs if needed; to maintain a budget and monitor expenditures in compliance with budgetary guidelines; to analyze data and interpret statistics; to create a variety of narrative, statistical, and budgetary reports, including trend analysis; to identify and resolve problems; and to interpret guidelines and regulations Work requires interpersonal skills necessary to provide leadership in team building endeavors; to collaborate with other BMC leaders and directors in support of hospital and departmental goals and objectives; to establish and maintain effective, cooperative working relationships with employees and managers; to act as a liaison to third-party representatives and represent the hospital's interests while negotiating and obtaining contracts; and to train employees. Outstanding Oral and written communications skills Demonstrated professionalism.
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