This role leads all aspects of the day-to-day operations of Patient Financial Services (PFS). The Director takes responsibility to set departmental goals in alignment with City of Hope values and objectives and works closely with the Vice-President of Revenue Cycle to ensure consistent improvements in PFS over time. The Director will manage the following revenue cycle processes: Pre-Billing, Billing, Collections, Patient Financial Services, Revenue Integrity and Vendor and Denial Management with the goal to provide excellent service to patients with expedient issue resolution. Providing visibility and predictability to cash flow planning is an important part of the role. The Director therefore acts as liaison/coordinator with Corporate Accounting, Reimbursement, Budget and Financial Planning, Human Resources, Marketing, Contract Negotiation, Legal, Compliance and others. The Director is responsible for leading and developing the PFS group. This extends from overseeing the development of policies and procedures; Developing internal and external communications but also fostering engagement of the employees in PFS. The Director also is able to leverage technology and process redesign to improve operational and organizational efficiencies.
Provides leadership and guidance for budgeting staffing and expenses for the PFS Team, Provides an A/R management framework, Functionally owns the ConnectHope (EPIC) implementation for PFS and participates in the relevant Steering Committees. Works proactively and closely with the compliance team on regulatory matters.. Ensures consistent and actionable communication with key physicians including co-chairing of the Charity Care Committee. Member of the Utilization Review Committee. Overall development of department and revenue cycle teams to ensure leadership and results. Extensive monitoring and reporting to revenue producing departments. Together with the Director for Strategic Revenue Management, ensure the development of a pricing and charge master design and maintenance including reporting to revenue producing departments.
Revenue Cycle Management
- Provide leadership and direction in the revenue cycle to meet key metrics for days in A/R, cash collections, A/R aging and CDM maintenance.
- Oversee Patient Billing, Collections, Customer Services, Refunds/Credit Balance, Payment Posting and Revenue Integrity inclusive of Charge Capture and CDM maintenance and updates.
- Develop, plan, direct and manage PFS activities through coordinated effort to lead PFS Managers and staff.
- Monitor the performance of all PFS functions.
- Establish appropriate revenue goals and monitor annual operating revenues.
- Collaborate with Revenue Cycle peers to accomplish the goals, objectives and strategic plan established for Revenue Cycle.
- Oversee the development and collaborate to update of policies and procedures. Develop internal and external communications and reports as needed.
- Provide information and updates on PFS development to VP of Rev Cycle, CFO, and other committees.
- Collaborate with VP of Revenue Cycle in monitoring monthly and annual departmental budgets.
- Create a culture of collaboration within the Revenue Cycle to improve effective and timely multi-directional communications and meet constant changes mandated by state and federal guidelines.
- Coordinates interactions among multiple organizational departments and functions.
- Evaluates potential “make/buy” decisions where outsourcing vendors and support activities are being explored.
Technology Systems Management
- Implements new technology, and acts as a catalyst for change to meet current and future business needs.
- Provide subject matter and technical expertise in the design and implementation of EPIC in Revenue Cycle and related applications.
- Functions as authority for all PFS decisions related to PFS information systems.
- Identifies, proposes, designs and implements applications which will enhance accounts receivable processes.
- Attract, retain and develop quality management and other team members, while providing leadership and role model
- Oversee the hiring, training and termination of employees.
- Counsel employees both ongoing and as part of the performance evaluation process.
- Communicate effectively with staff to keep them informed of changes within and outside applicable departments
- Facilitates a cross-training work force to build a cohesive work environment.
- Utilizes strong communication skills and cultural competencies to maintain with sensitivity in a culturally diverse work force.
- Design programs to recruit and retain the best staff, develop a culture of pride and ownership and provide opportunities for learning and growth.
Quality and Compliance
- Service quality and work quality to meet required COH, state and federal rules and regulations.
- Utilizes work quality monitoring to insure that policies and procedures, objectives, performance improvement, attendance, safety and environment, and infection control guidelines are followed.
- Adhere to current organizational Performance Improvement priorities.
- Participate in quality studies through data collection.
- Make recommendations and take actions to improve structure, system or outcomes.
- Insures that compliance to rules, regulations, operations, contracts, internal and external rules, state and federal requirements are met.
Follows established City of Hope and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace Code of Conduct and Compliance Plan. Practices a high level of integrity and honesty in maintaining confidentiality.
Performs other related duties as assigned or requested.
The following shared, organization-wide competencies describe the desired behaviors that will facilitate success at City of Hope:
- Communication - Expresses ideas clearly and constructively (written and spoken, upward and downward, one-on-one and with groups).
- Customer Service - Seeks to understand customer needs and works to exceed customer expectations (internal and external).
- Initiative - Looks for opportunities to improve performance; manages time, work, and relationships effectively and efficiently.
- Professionalism - Treats others with respect; abides by the institutional values; displays a positive and cooperative attitude; adheres to the workplace Code of Conduct and compliance policies.
- Stewardship - Identifies efficiencies to reduce redundancy and/or elimination of tasks resulting in savings of cost, resources, and or/time.
- Teamwork - Works proactively and collaboratively with others to streamline work and achieve mutual goals.
The position directly supervises:
- Manager Government Manager
- Manager Cash Applications/Customer Service
- Manager, Vendor Management
- Manager, Denial Management
- PFS Coordinator/Analyst
- Sr. Secretary
- Bachelor’s Degree
- 5 years prior PFS experience
- Ongoing education in Healthcare Management Administration, Revenue Cycle
- Master’s Degree (MPH, MPA, MBA) Preferred
- Accounts Receivable, AR management systems applications
- Certified Healthcare Financial Professional (CHFP)
- Large Health Systems
- Excellent People’s skills
- MS Office (Word, Excel, PowerPoint, Visio, Project)
- PC, lap top, A/R systems, Eclipsys, Registration, QMS ; access all these continuously throughout the day. High utilization of systems management.
Working / Environmental Conditions:
- Work is primarily performed within an office setting; light lifting; Frequent meetings and walking to sites required.