Director, Medical Claims Data Analysis

Overview:
Catholic Health is one of Long Islands finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace

Job Details:
Works directly with hospital CAO, SVP Physician Network and physician leaders to support the financial and operational performance of physician practices. Responsible for development of annual budgets; provides expertise in front-end best practices; serves as liaison to IT related to technology support Epic implementations; interacts with central business office related to billing and collections activities; identifies opportunities for standardization and performance improvement; develops, implements and monitors corrective action plans; oversees workforce development for practice staff; coordinates reviews related to coding/compliance, environment of care, safety/infection control, facilities; recommends changes in clinical and administrative staffing supported by benchmarking or ROI analyses.

DUTIES/RESPONSIBILITIES:
Ensures operational efficiency of physician practices. Coordinates administrative functions to support program development.
Assists in developing and maintaining objectives, policies and procedures to ensure the efficient operation of assigned physician practices.
Demonstrates the ability to work with administrative leadership, physicians and other clinical personnel to develop, implement and oversee clinical programs.
Strives to streamline operations and effectively apply new concepts and techniques for positive outcomes; identifies and implements technology to improve operations.
Coordinates activities including growth objectives, space allocation, procurement of technological equipment, data planning, developing goals and objectives, capital requirements and desired outcomes of programs.
Reviews comprehensiveness of programs on an ongoing basis and develops strategies for program adaptation to market changes.
Participates in monitoring and evaluating a program's inception and performance and routinely monitors performance per volumes, referrals and trends.
Structures the appropriate flow of data to ensure timely and appropriate management of clinical and financial issues.


~ Demonstrates ability to manage clinical departments in a fiscally responsible manner.

Assists in the preparation and monitoring of annual budgets - operational, personnel and capital.
Develops and presents annual budgets, including forecasting of revenue trends and expense analyses.
Monitors budgetary variances and progress in budget revenue performance and communicates to leadership.

~ Serves as liaison to central business office related to billing and collections performance for practices. Coordinates implementation of standards with revenue cycle management team.

~ Develops and monitors performance criteria related to:

Front-end patient data acquisition and management
Appointment scheduling, patient registration, insurance verification, data entry, charge and diagnosis assignment and charge capture activities
Front-end billing operations key indicators including denial trending analyses and co-pay collection
Error reports, claim processing reports, accounts receivable reports and any pertinent ad hoc reports.
Ensures integrity and meaningfulness of reports and timely availability of information. Reviews and analyzes reports on a daily and monthly basis. Analyzes variances and identifies opportunities for improved results.
Identifies problems in the process flow or organizational structure that impedes financial outcomes, proposes solutions and collaborates with departments to implement corrective action, including:
Allocation of resources related to front-end functions
Training of staff related to key revenue cycle functions
Availability and use of technology and automated tools that support
revenue initiatives
~ Development and revision of policies and procedures

Assists in the development of annual revenue projections for the departments.
Oversees development of short and long-term action plans and goals to improve department specific billing operations and performance.

~ Performs related duties as required.


~ Demonstrates and promotes respect for patients rights.

Demonstrates awareness of and compliance with the Patients Bill of Rights and the Patient Self Determination Act.
Maintains patient confidentiality.
Assists in making reasonable accommodations for special groups, i.e., hearing and visually impaired and physically challenged.

POSITION REQUIREMENTS AND QUALIFICATIONS:
MINIMUM REQUIREMENTS

Education:
Bachelors degree required or equivalent work experience within an academic medical center, physician practice and/or hospital setting.
Masters degree in Business Administration, Health Care Administration or related field preferred.
A minimum of five years work experience in a physician practice with a focus on operations management and physician reimbursement, preferably within a health system.

Skills:
Ability to train professionals in the identification, valuation and realization of revenue opportunities within physician practices.
Proven track record of accountability and results related to performance improvement within physician practices.
Extensive knowledge of reimbursement guidelines from government and third party payers, and ability to identify and realize revenue opportunities based on development and implementation of corrective action plans.
Excellent interpersonal, oral and written communication skills.
Strong organizational and project management skills.
Excellent judgment and creative problem solving skills.

Experience:
Minimum of five (5) years managerial experience in a physician or hospital setting required; experience in off-site practice management preferred.
Extensive knowledge of physician practice operations and best practice industry standards.
Extensive experience in the knowledge and use of practice management system(s).

Posted Salary Range:
USD $120,000.00 - USD $160,000.00 /Yr.
:
This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidates qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.
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