Executive Director, Revenue Cycle Operations

JOB PURPOSE: Reporting to the CFO, the position will lead all activities, processes and functions of Revenue Cycle Operations for the hospital and all affiliated clinics and practices of the organization in accordance with all state and federal regulatory mandates, Joint Commission standards and in accordance with CMS. Responsible for tracking and maintaining all key revenue cycle metrics. Will determine and implement appropriate division structure, budgets and goals agreed upon by the CFO for the Department for Patient Access, CBO, including both hospital and professional billing, and HIS. Ensure optimal functioning of the operations to ensure revenue maximization for the organization. # # ##DUTIES AND RESPONSIBILITIES: Exemplifies Hospital#s values and Service Excellence standards. Commits to making every encounter with our patients, patients# family, co-workers, physicians and other customers the best that it can be. Complies with all Hospital policies and the Code of Business Conduct. Takes responsibility for own safety as well as the safety of patients, patients# family, co-workers, physicians and other customers. Oversees and directs activities of the following departments: Patient Access, CBO and HIS Interviews, hires, orients, coaches, trains, and evaluates Director Patient Access, Director Patient Financial Services, Director Provider Billing Services, Director HIS. Collaborates with Human Resources on recruitment and retention strategies. Analyzes turnover data and, as necessary, develops action plans. Facilitates employee opinion survey process for#Patient Access, Patient Financial Services, Provider Billing Services and HIS and, as necessary, develop action plans. Recommends goals for Patient Access, Patient Financial Services, Provider Billing Services and HIS to Vice President and implements agreed upon goals. Recommends budgets for Patient Access, Patient Financial Services, Provider Billing Services and HIS to Vice President and implements agreed upon budget. As necessary, completes budget variance reports. Provides leadership and works with all hospital and clinic based VP#s and Directors across the organization to improve and maintain best in practice revenue cycle functions - including all areas of Patient Access, Patient Billing and HIS, Charge capture, etc. and is a resource to all department directors, physicians, Leadership and managers for anything related to these departments. Keeps staff informed of all hospital events, initiatives etc. At a minimum holds monthly staff meetings. Develops and oversees implementation of policies and procedures to support Patient Access, Patient Financial Services, Provider Billing Services and HIS functions. Ensures compliance with all regulatory requirements for Patient Access, Patient Financial Services, Provider Billing Services and HIS. Oversees the Joint Commission survey process for Patient Access, Patient Financial Services, Provider Billing Services and HIS. Continual review of the revenue cycle to identify areas which need improvement in order to ensure that all appropriate avenues of revenue are being billed, appropriate reimbursement is obtained, and that continual improvement occurs. Stay abreast of all new billing regulatory changes including LMRP (Local Medical Review Policy) and disseminate to appropriate clinical areas as well as to Patient Access, Patient Financlal Services and Provider Billing Services and HIS. Oversee the review of the Charge Department Master yearly to ensure compliance with Medicare and other payers and to ensure that we maximize revenue. Oversees and coordinates the periodic software updates for various software applications utilized by the departments. Identify specific areas of user training needs within the revenue cycle and facilitate performance improvement process teams. Perform a yearly review of the claims dictionaries in Meditech to ensure the appropriate revenue codes, CPT codes and modifiers are being utilized in conjunction with the Charge Department Master and with regulatory requirements and payor contracts. Oversee the coordination of all post-payment audits from our payors to identify areas of revenue opportunities by improving chart documentation. Oversee the reporting of monthly analysis of denial tracking to identify and implement all opportunities for revenue improvement. Participates in the following: Mandatory training requirements as per hospital/unit policies Continuing education to enhance knowledge Staff meetings Performance improvement initiatives Orientation of new staff, students and/or volunteers

JOB PURPOSE: Reporting to the CFO, the position will lead all activities, processes and functions of Revenue Cycle Operations for the hospital and all affiliated clinics and practices of the organization in accordance with all state and federal regulatory mandates, Joint Commission standards and in accordance with CMS. Responsible for tracking and maintaining all key revenue cycle metrics. Will determine and implement appropriate division structure, budgets and goals agreed upon by the CFO for the Department for Patient Access, CBO, including both hospital and professional billing, and HIS. Ensure optimal functioning of the operations to ensure revenue maximization for the organization.

DUTIES AND RESPONSIBILITIES:

* Exemplifies Hospital's values and Service Excellence standards. Commits to making every encounter with our patients, patients' family, co-workers, physicians and other customers the best that it can be.
* Complies with all Hospital policies and the Code of Business Conduct. Takes responsibility for own safety as well as the safety of patients, patients' family, co-workers, physicians and other customers.
* Oversees and directs activities of the following departments: Patient Access, CBO and HIS
* Interviews, hires, orients, coaches, trains, and evaluates Director Patient Access, Director Patient Financial Services, Director Provider Billing Services, Director HIS. Collaborates with Human Resources on recruitment and retention strategies. Analyzes turnover data and, as necessary, develops action plans. Facilitates employee opinion survey process for Patient Access, Patient Financial Services, Provider Billing Services and HIS and, as necessary, develop action plans.
* Recommends goals for Patient Access, Patient Financial Services, Provider Billing Services and HIS to Vice President and implements agreed upon goals.
* Recommends budgets for Patient Access, Patient Financial Services, Provider Billing Services and HIS to Vice President and implements agreed upon budget. As necessary, completes budget variance reports.
* Provides leadership and works with all hospital and clinic based VP's and Directors across the organization to improve and maintain best in practice revenue cycle functions - including all areas of Patient Access, Patient Billing and HIS, Charge capture, etc. and is a resource to all department directors, physicians, Leadership and managers for anything related to these departments. Keeps staff informed of all hospital events, initiatives etc. At a minimum holds monthly staff meetings.
* Develops and oversees implementation of policies and procedures to support Patient Access, Patient Financial Services, Provider Billing Services and HIS functions.
* Ensures compliance with all regulatory requirements for Patient Access, Patient Financial Services, Provider Billing Services and HIS. Oversees the Joint Commission survey process for Patient Access, Patient Financial Services, Provider Billing Services and HIS.
* Continual review of the revenue cycle to identify areas which need improvement in order to ensure that all appropriate avenues of revenue are being billed, appropriate reimbursement is obtained, and that continual improvement occurs.
* Stay abreast of all new billing regulatory changes including LMRP (Local Medical Review Policy) and disseminate to appropriate clinical areas as well as to Patient Access, Patient Financlal Services and Provider Billing Services and HIS.
* Oversee the review of the Charge Department Master yearly to ensure compliance with Medicare and other payers and to ensure that we maximize revenue. Oversees and coordinates the periodic software updates for various software applications utilized by the departments.
* Identify specific areas of user training needs within the revenue cycle and facilitate performance improvement process teams.
* Perform a yearly review of the claims dictionaries in Meditech to ensure the appropriate revenue codes, CPT codes and modifiers are being utilized in conjunction with the Charge Department Master and with regulatory requirements and payor contracts.
* Oversee the coordination of all post-payment audits from our payors to identify areas of revenue opportunities by improving chart documentation.
* Oversee the reporting of monthly analysis of denial tracking to identify and implement all opportunities for revenue improvement.
* Participates in the following:
* Mandatory training requirements as per hospital/unit policies
* Continuing education to enhance knowledge
* Staff meetings
* Performance improvement initiatives
* Orientation of new staff, students and/or volunteers