Director System Patient Financial Services

Purpose of position

Develops and executes the strategic vision for Patient Financial Services (“PFS”) functions across all Cape Cod Healthcare ("CCHC") entities. Provides leadership and oversight of key operational and financial decisions pertaining to all insurance and patient Accounts Receivable (“AR”) resolution, denials management, customer service and billing compliance. Coordinates with the VP of Revenue Cycle and/or CFO to develop yearly metrics and is responsible for managing people and processes to achieve or exceed CCHC’s revenue cycle goals and performance metrics expectations. Has responsibility to timely budget submission and ongoing management to budget expectations.

Leads or serves on CCH revenue cycle process improvement task forces and committees.

Primary duties and responsibilities

Directs the performance of CCHC Patient Financial Services Accounts Receivable (AR) including but not limited to Billing, Insurance Follow-Up, Customer Service, Denials Prevention and Management and Vendor Management. Responsible for hiring, coaching, and otherwise developing direct reports and creating or ensuring creation of a structure for employee onboarding and ongoing development.

Collaborates with the CFO and VP of PFS & Revenue Cycle to set goals, identify opportunities to improve AR resolution, resulting in payment based on industry Key Performance Indicators (“KPIs”) for Patient Financial Services and Revenue Cycle. Responsible for measurement and reporting of ongoing financial and operational performance.

Ensure the implementation of action plans where performance is not meeting expectations and recognizing areas of excellence. Lead the implementation of best practice strategies to increase cash flow and turnaround time in account resolution.

Demonstrates a commitment to exceptional customer satisfaction to all parties. Appropriately assesses who our customers are (e.g. anyone the individual has a responsibility to serve inside and/or outside the Health System).

Conducts self in a polite, forthright manner, articulately communicating with others and using discretion, judgment, common sense and timeliness in customer service decision -making. Create, monitor and perform within established budgets.

Develop, implement, and manage efficient and effective operational policies, procedures, processes and performance monitoring across all Patient Financial Services functions. Ensure that all PFS employees and process owners are held accountable and are meeting established standards and goals.

Ensure PFS employees across all functions are trained and comply with established policies, processes, and quality assurance programs. Identify potential process improvements through Patient Financial Services, and lead the design and implementation as required.

Coordinate and oversee all third party AR and payment application process transition points between Patient Financial Services and other functional areas within the revenue cycle organization. Monitor and facilitate service level agreements (“SLAs”) between Patient Financial Services and other related functions, within both Revenue Cycle and Clinical Operations as necessary.

Coordinate with peers across the Revenue Cycle organization, and with related stakeholders, on the management of third-party denials by working with the onsite Revenue Cycle Integration leaders, Patient Access Services and middle Revenue Cycle functions, Professional Revenue Cycle, Home Health and Hospice, and Behavioral Health to identify trends and implement denials prevention and/or recovery programs. Routinely conduct payer trend analysis to ensure optimal processing and reimbursement, identify issues, communicate findings to CCHC PFS stakeholders, define solutions and initiate resolution.

Coordinate with peers across the Revenue Cycle organization on the management of PFS edits by working with the Unbilled Committee to identify trends and implement modifications to workflow to limit pre-billing edits. Build strong relationships and facilitate productive communication between key revenue cycle stakeholders, including peer leaders of Revenue Cycle services and core support departments (e.g., Human Resources, IT, Finance, Managed Care, etc.)Develop and maintain effective payer working relationships.

Assess direct reports’ performance on a consistent basis and provides feedback to reward effective performance and enable proactive performance improvement steps to be taken. Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.

Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.

Education/experience/training

Bachelor's degree in Business Administration, Healthcare Management or related discipline preferred or the equivalent combination of education and experience. Minimum of five to seven years of relevant experience with a track record of progressively responsible positions in a complex healthcare organization such as a multi-hospital system, large group practice or a major healthcare consulting firm preferred.

Minimum of three to five years of supervisory/management experience. Prior experience in a union environment preferred.

Strong technical grounding, project management and implementation experience required. Proven leadership abilities and comprehensive knowledge of healthcare information systems.

Epic Single Business Office (SBO) and clearinghouse experience preferred. Strong working knowledge of regulatory requirements, payer requirements, billing coding requirements (ICD, CPT, HCPCs, etc.), general revenue cycle management strategies, and industry best practices.

Thorough knowledge of metrics, analytics, and data synthesis in healthcare patient financial services and revenue cycle management to identify trends, produce reliable forecasts and projections. Strong analytical and critical thinking, organizational, and business process optimization skills, with in-depth ability to develop and pursue goals, synthesize data to identify system vulnerabilities and develop and apply innovative solutions.

Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. An understanding of the psychology of complex corporate relationships, and an ability to influence within such an environment.

Excellent communication and organizational skills are required, with the ability to effectively communicate to physicians, patients, staff, payers and administration. Above average understanding of how, when, and to what extent different hospital departments relate to and communicate with one another.

Pay Range Details:The pay range displayed on each job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education.

This is not inclusive of the value of Cape Cod Healthcare’s benefits package (if applicable), which includes among other benefits, healthcare/dental/vision and retirement. For annual salaries this is based on full-time employment.