Job Description

Job Summary

Responsible for the support of the UCSF Revenue Cycle Quality and Education Department and supporting programs/projects. Supports metrics administration and performs ongoing metrics surveillance and analysis of registration quality and other access and revenue cycle functions to support the Director, Patient Access Services and Revenue Cycle Quality and Education. This position serves as support to the revenue cycle departments and the enterprise in its work with the Medical Group (MGBS and the Office of Revenue Management), Patient Financial Services, Patient Access Services, Ambulatory Services and Faculty Practices, Ancillary Units, Clinical Services, affiliates, and APeX Financial and Clinical Systems teams encompassing efficiency, quality and standardized revenue cycle performance, as well as, optimization of APeX revenue cycle patient access applications and back-end revenue cycle operational processes and systems across the clinical enterprise. Responsibilities include business data quality review, performance monitoring, identification and analysis of patient access quality defects, training and education requirements, month-end data and reporting capture and metrics dashboard management. Additionally, this role is responsible for preparing reports and provides analyses in an accurate, comprehensive and timely manner to Revenue Cycle leadership. Also, assists director in the planning and development of financials and other applicable projects.

Responsibilities

of time

Essential Function (Yes/No)

Key Responsibilities

(To be completed by Supervisor)

55

Analyzes highly-complex financial data and identifies trends in revenue cycle functions and integration of operations. Delivers comprehensive reports and presentations to leadership, to include proposals and solutions to maximize revenues.

Develops dashboards and processes for continuous management and analysis of revenue cycle functions. Develops and proposes new or changing components of the revenue integrity program, to maximize revenues and increase efficiencies.

Leads and / or monitors progress and priorities on projects. Collaborates with departments across the system to assimilate and define needs, develop goals and metrics, and define system requirements and capabilities.

1. Performs data analysis and report generation specific to revenue cycle operations and functions.
2. Able to perform special studies/projects complex in scope, which require independent development of innovated analytical approaches to resolve issues related to financial management, revenue cycle process, IT systems and/or other automated systems. Key emphasis is patient liability policy review and revision and development of education, training, guidelines, communication and scripting of self-pay discount policies and procedures.
3. Works directly with revenue cycle owners and unit managers in the building of report data, data validation and report production.
4. Prepares written status reports for Revenue Cycle Quality and Education leadership on project progress, next steps, time frames and other requested topics.
5. Effectively communicates with revenue cycle leaders, managers, super users and other key constituents.
6. Develops and effectively documents standards, policies and control requirements in collaboration with director.
7. Supports the production and reporting of key revenue cycle measures, benchmarks and analytics that will promote overall revenue cycle efficiency, operational and financial optimization, and the patient experience.
8. Performs other duties as assigned by Management.

Specifically:

• Supports and develops and co-develops with APeX training and operator teams staff training in response to defined training curriculum and delivery modes. Delivers training methods and curriculum and monitors training compliance where appropriate.
• Working with director, drafts system and policy changes and standardized communications.

In partnership with colleagues in operations and APeX, this position, provides analysis, scrutiny and assessment of workflow, work queues and process in the following areas:

• Patient Access Services
  
  • Admissions and Financial Counseling (Central Admitting and Transfer Center)
  • Registration (Inpatient, Ambulatory, ED, L&D, Home Health, etc.)
  • Cadence Scheduling
  • Referral Management
• Pre-Service, Access and CAU, and CCS Auth Units
• Patient Financial Services
  
  • Billing
  • SBO
  • Account Follow-up and Denial Management
  • Cash Application
  • Customer Service

The position routinely works with the following areas:

• Revenue Management/Revenue Integrity
• Patient Access Services managers and staff
• Revenue Cycle Patient Access Super Users
• Professional Billing (MGBS) - in particular, Client Service Managers
• Hospital Billing Services (Patient Access and PFS)
• Ambulatory managers and super users
• Clinical Services managers and super users
• Faculty Practice administration
• APeX configuration, reporting, and training teams

All the above processes and procedures must be completed in accordance with the HIPAA mandated rules, regulations and requirements and in accordance with UCSF Medical Center and PFS Department policies.

20

Process Improvement

• Serves as a technical leader and resource in evaluating revenue cycle workflows to propose improvements in efficiencies and timeliness. Provides guidance and expertise in the development of highly-complex workflow improvements to integrate practices.
• Develops and implements changes to systems, policies and procedures to maintain currency in government regulations, reimbursement issues and other matters having potential financial impact.
• Recommends and implements new processes and systems to improve charge integrity, reconciliation and charge linkages from ancillary charging systems for the medical center / health system.
• Recommends and designs structured workflow improvements.
• Identifies opportunities for revenue cycle rapid cycle improvement; participates in LEAN programs

25

Quality and Education

• Develops and delivers training to patient financial services units on revenue cycle systems, processes and procedures. Patient finance areas include registration, insurance verification, financial counseling and authorization processes.
• Contributes to the Design of processes to achieve high level of data capture and transactional accuracy and quality throughout the revenue cycle
• Works with operators and training departments to help define, develop, organize, and implement training programs for employee development and on-the-job training across all applicable departments.
• In collaboration with director, develops departmental training and cross training for staff and clinicians across the medical center revenue cycle. Partners with the Clinical Services departments, HODs, and ambulatory practices in utilizing administrative and quality data to target training needs in the areas of scheduling, pre-registration, registration, insurance verification, authorization, financial clearance, cashiering, compliance, revenue cycle overview, and other revenue cycle functions as required.
• Supports the design and implementation of revenue cycle quality improvement systems, metrics, dashboards, reports, and methodologies.
• Works with teams to define and refine quality measurements, benchmarks, and employee expectations.
• Conducts performance audits on scheduled and unscheduled intervals analyzing data, observing processes and shadowing job activities to identify workflow optimization opportunities. Identifies and collaborates toward report development, proper distribution and usage of reports.

100%

Qualifications

Required Qualifications

• Bachelor's degree in Accounting, Finance, Business or other related field and / or equivalent experience / training.
• At least five (5) years of combined experience in any of the following areas: healthcare revenue cycle, finance, patient access, clinic administration/operations, revenue and A/R reporting, financial analysis, finance and audit
• Healthcare revenue cycle management, analysis and reporting experience
• Experience in operation metrics, financial metrics or performance metrics
• Proficient in use of MS Office applications (Word, Excel, Outlook, Access, PowerPoint, Visio)
• Prior experience working on healthcare systems like SMS, IDX, EPIC
• Demonstrated ability to determine the key risks that need to be addresses and develop action plans for director review that are multi-faceted in nature and include both business process and system components
• In-depth knowledge of the practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.
• In-depth understanding of the issues, processes, reporting instruments, metrics, dashboard design, and other tools and techniques involved with measuring and analyzing the revenue cycle.
• Advanced organizational and project management skills, and ability to lead a team, prioritize tasks, and see projects through from inception to completion on schedule.
• Advanced communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner. Ability to prepare compelling and informative reports and presentations to all levels of staff and management.
• Advanced analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems in revenue cycle program areas, to identify weaknesses and develop innovative solutions and process improvements.
• Advanced interpersonal skills, with the ability to collaborate effectively on highly-complex projects in a team environment with a wide variety of business and clinical areas.
• Strong ability to advise management, serving as a technical expert, providing proposals for improvement and guidance on regulatory changes and industry trends and developments in revenue cycle management.

Preferred Qualifications

• Certification by a third party association that matches the related function or field
• Advanced skills in report development, dashboard design, and various software tools specific to healthcare revenue cycle management. Skills in common database, spreadsheet and presentation software.
• Understanding of revenue cycle processes, requirements and best practices, including Enrollment, Scheduling, Pre-registration, Registration, Patient Access Services , Financial Counseling, Charge Master, Coding, Charge Capture, Billing, Collections, Bad Debt, Payment Processing, Denial
• Management, Revenue Recognition and Accounts Receivable Finance Operations
• Familiarity with the role that Utilization Review, Case Management, HIMS and Compliance has on reimbursement.
• Experience in large consulting organizations
• Thorough knowledge of Revenue Cycle experience