Job Requirements
The Sr. Director of Revenue Cycle has the overall accountability for maintaining a properly functioning revenue cycle process. This position is responsible for the strategic initiatives, planning, program development, labor management and overall administration of Patient Financial Services.
The revenue cycle operations function serves as support for the strategic, operational, and financial direction of the Central Business Office (CBO).
Serves as the primary liaison between the corporate Revenue Cycle teams and Entity leadership. Works closely with the Entity CFO, Entity Leadership team and the corporate Revenue Cycle departments, and is responsible for the proactive oversight of the Entity/Client relationship and Entity Revenue Cycle results, including (but not limited to) Charge Edits, Denials, Net Revenue Realization, Days in A/R, month end reserve process, and review/approve manual adjustments (per threshold). Develops a deep understanding of the Entity's revenue cycle, which includes a thorough understanding of Epic and any applicable systems and tools, the entity charge capture and processes, and billing requirements. Proactively identifies opportunities for revenue cycle improvement and partners with the Entity and corporate Revenue Cycle leadership to develop and execute these plans. Provides the Entity and corporate Revenue Cycle leadership with interpretation of standard operational, financial, and billing statistics on a monthly basis. Establishes and ensures leading practices and operations consistent with UMMS's corporate Revenue Cycle, policies and procedures are followed in the local Entity environment. Provides strategic guidance and direction on key Entity Revenue Cycle-specific operational and financial decisions. This role is a critical role in the success of the revenue cycle of each entity.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
Key Responsibilities:
1.Collaborates with Executive Sr. Vice President & CFO of UMMS as well as the Chief Financial Officers for each of the hospitals in developing and executing enterprise-wide standardization and efficiency visions and strategies that support overall performance.
2. Establishes financial performance standards, goals, and targets for each facility within UMMS. Leads and develops strategies to ensure best practices are utilized throughout the Revenue Cycle. Develops long term strategic plans for future state processes and structures.
3. Responsible for revenue cycle operations activities, policies, and strategies to ensure effective and maximized collections for outstanding receivables. Develops strategic, cost-effective programs, and makes system or operational changes to enhance overall UMMS performance.
3.1. Establishes and manages effective, consistent communication with UMMS Entities; identifies and addresses business needs; conducts regular meetings with Entity leadership and key entity leadership. Provides analysis and context for monthly performance data. Documents, escalates, and manages the resolution of issues that arise and impact both entity onsite and centralized Revenue Cycle operations.
4.Ensures compliance with relevant regulations, standards, and directives from Compliance and regulatory agencies. Stays well informed with ongoing healthcare and legislative changes, competition, and best practices to plan and execute strategic initiatives, education plans and audits to mitigate organizational risk.
5. Analyzes key performance metrics and trends within the AR for all facilities and uses this information to lead change for improvements.
6. Directs and manages the performance of various departmental staff through subordinate managers, including hiring, firing, disciplining, training, development, and performance review in accordance with UMMS Human Resources policies and procedures.
7. Creates standard revenue cycle reporting tools and analyses that are used to communicate monthly, quarterly, annual and periodic performance levels. Provides contextual summary of the reports generated to understand the trends identified and assists with developing strategies to address any burgeoning issues.
7.1. Assists in the identification of key elements which have a direct impact on revenue collections and develop information and administrative systems to capture critical statistics; report information to CFOs and other key stakeholders; key elements considered are days in AR, collection ratios, aged accounts receivable, denial ratios, etc.
7.2. Analyzes the utilization of information systems related to the flow of intra-departmental information and third-party payor; recommends enhancements to software and/or hardware, as appropriate with the objective being to improve the lack of information between entitles and that will expedite the performance tracking of registration, billing, collection and medical record coding.
8. Directs and manages the performance of revenue operations departmental staff. Specific revenue operations departments include Revenue Analytics, Vendor Management, Denial Management, Budgetary Compliance, and Customer Service departments:
8.1. Ensures that standards of productivity are established and followed.
8.2. Assures appropriate administration of the financial systems and business practices to department and ensures Human Resources policies and procedures are followed by subordinate management staff. Communicates and interprets relevant policies and procedures to staff, as needed.
8.3. Participates in the development of departmental objectives and organizational structure.
8.4. Incorporates the facility's values into all business staff development practices and all department activities.
9. Develops strategies and processes to support the self-pay revenue cycle, including outsourcing protocols and controls, patient collection policies and vendor management standards.
9.1. Serves as vendor relationship executive for all outsourced self-pay receivables. In conjunction with supporting managers and staff, sets policy for all self-pay practices.
9.2. Meets with vendor leadership to review performance and confirm adherence to UMMS self-pay policies.
9.3. If necessary, conducts vendor assessments and drives new vendor selection processes.
9.4. Ensures appropriate departmental controls are in place to monitor daily activity and staff productivity. Establishes performance standards and expectations and communicates them effectively.
9.5. Responsible for all month-end reporting, and receivables reporting to Finance. Maintain compliance standards for providing accurate information on all Entity billings.
10.Demonstrates, through plans and actions, that there is a consistent standard of excellence to which all departmental work is expected to conform.
10.1. Establishes standards maintaining a constancy of purpose, focusing on continuous improvement within all areas of influence delivering the highest degree of quality service possible.
10.2. Analyzes and resolve problems that effect revenue cycle performance, regardless of whether the problem originates under direct or indirect control.
10.3. Makes significant contributions to the organizational financial performance of UMMS hospitals support through revenue cycle process improvement.
10.4. Directs, leads and/or supports integration activities for new UMMS Entities, as directed by Vice President.
Work Experience
Education and Experience
1. Bachelor's Degree in Business Administration, Financial Management or an equivalent related field is required. Master's degree in Health Care Administration or Business Administration preferred.
2. At least ten (10) years progressively responsible experience in revenue cycle operations of which at least five years should be in academic medical setting or a large, centralized business office.
Knowledge, Skills and Abilities
1.Comprehensive understanding of the entire revenue cycle operation, including that of Health Information Management and their role in supporting financial and clinical performance outcomes, Specifically as it relates to the security of illness, APR DRG assignment, clinical documentation, time-lines of billing, as well as The Joint Commission (TJC) and HIPPA requirements.
2. Working knowledge in the areas of patient registration, billing, accounts receivable (AR) and Cash Management requirements, Managed Care contractual terms and requirements, health insurance practices, industry regulatory requirements, business office operation, AR and financial reporting technology, basic accounting and industry standards for healthcare revenue resolution management practices.
3. Superior financial management skills, including the ability to financially analyze data for operation, auditing, forecasting; basic accounting knowledge; AR and reserve analysis, and financial reporting skills.
4. Proficient project management, analytical and problem-solving skills that allow strategic thinking alongside detailed task management.
5. Ability to make quality, independent decisions as well as the ability to collaborate effectively to make decisions with other leaders.
6. Knowledge of federal and state Medicare and Medicaid regulations, as well as contractual requirements related to managed care programs is necessary.
7. Ability to direct a large, multidiscipline staff through subordinate management personnel to achieve integration of performance standards. Ability to create, develop, and implement staff in-service educational programs.
8. Highly effective communication skills are requirements to ensure satisfactory patient/physician relations are maintained and to communicate with all levels of staff.
