The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.
Assesses and responds to organizational and customers' needs with innovative programs to ensure customer satisfaction. Implements patient friendly billing guidelines.
Completes/contributes to the completion of various financial forecasts, including cost center salary and direct expenses, month-end financial reporting, receivables levels (net matched collections, days in AR (Accounts Receivable)and aging), reserve analysis, cost center productivity, benchmarking, and any long-range strategic plans for the department.
Directs ongoing programs for staff development and training that fosters and mentors the next generation of Revenue Cycle leaders.
Ensures compliance with relevant regulations, standards and directives from regulatory agencies and third- party payers.
Maintains and fosters excellent payer relations with key fiscal intermediaries and government oversight agencies such as CMS, Medi-Cal, DHS, etc. Maintains and fosters excellent relationships with contracted health plans and medical groups to support effective claims submission/resolution and contract compliance. Maintains a climate of confidence in the billing process and results, with Department Chairs, physician leadership, and DFAs.
Maintains appropriate internal control safeguards over AR records, write-offs and collection of cash. Maintains compliance standards for providing accurate information on all facility or health system billings.
Manages all service programs, including external vendor programs and systems.
Manages, prepares and presents capital and operating budgets that demonstrate prudent use of organization's resources while at the same time achieves and maintains organizations goals and key performance indicators.
Monitors and support daily staff functions. Participates in key Revenue Cycle stakeholder venues such as physician and clinic leadership venues, IT, Contracting, and Department of Finance Administrators (DFAs). Oversees the financial interface between and performance analysis of the patient financial services functions and fiscal services functions. Oversees the integrity of financial and clinical interfaces, while facilitating the development of strategic system planning.
Performs related duties such as selecting and evaluating the performance of key reporting staff; preparing various reports, correspondence and position papers; conducting and/or attending meetings and conferences and serving as the department's primary appointing authority.
Plans, coordinates and prepares year-end audits with public accounting firms and third-party auditors as they relate to AR operations. Mediates and resolve conflicts regarding public accounting firms, third-party auditors and investigate parties.
All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, protected veteran status or on the basis of disability.
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"We have a culture of patient care first here, one that speaks to our mission and our values: to care, to educate, and to discover."Brian L.Unit EducatorBSN, CMSRN
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Education: Bachelor's degree in a work-related field/discipline from an accredited college or university
Experience: Ten (10) years of progressively responsible and directly related work experience in patient billing management
Knowledge, Skills, and Abilities:
These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.
Ability to anticipate healthcare trends and alter the financial direction of the organization as necessary.
Ability to assess and keep current and compliant with all charity care, free bed fund and uninsured policies.
Ability to communicate complex concepts in simple form to non-finance users to understand the appropriate use and limits of the information provided.
Ability to develop financial budgets and manage expenses.
Ability to effectively influence change and manage effective the change process.
Ability to evaluate appropriate and key partnerships such as outsourcing, collections, underpayment vendors, eligibility, etc.
Ability to foster effective working relationships and build consensus.
Ability to keep operations technology up to date both in terms of legacy systems, EDI capable as well as added value tie in technologies.
Ability to provide leadership and influence others.
Knowledge of all functional areas of the revenue cycle, including health information management, case management, and charge capture.
Knowledge of computer systems and software used in functional area.
Knowledge of financial statements and the impact of the revenue cycle on them, including aging reports, bad- debt analysis, and calculation of bad-debt allowance.
Knowledge of local, state and federal regulatory requirement related to the functional area.
Knowledge of patient registration, billing, A/R, cash-management requirements, managed care contractual terms and requirements, health insurance practices, industry regulatory requirements (compliance and HIPAA), business office operations, A/R and financial reporting technology, wage and hour regulations, basic accounting and industry standard for healthcare revenue resolution management practices.
Knowledge of principles and practices of organization, administration, fiscal and personnel management.
- Req: 43181