Senior Business Partner for Revenue Cycle Management

2 weeks ago

Quincy, Massachusetts, United States Boston Medical Center Full time

Position:
Senior Revenue Cycle Business Partner

Department:
PFS Administration

Schedule:
Full Time

POSITION SUMMARY:


Under the guidance of the Senior Director of Revenue Cycle Operations, the Senior Revenue Cycle Business Partner (SRBP) plays a crucial role in managing hospital and professional insurance denials. This position collaborates with various teams including revenue cycle, compliance, clinical, and finance to ensure optimal operational efficiency.

The SRBP is tasked with analyzing system challenges and coordinating with vendors to enhance overall effectiveness.

This role also involves developing departmental policies and aligning team resources to meet the objectives and key performance indicators (KPIs) of both Hospital Billing (HB) and Professional Billing (PB) Revenue Cycle.

The Senior Revenue Cycle Business Partner meticulously reviews and generates reports to pinpoint trends and identify process deficiencies, striving to maximize revenue and reimbursement for Boston Medical Center.

Additionally, the SRBP assists in the implementation and evaluation of new EPIC Work Queues and system improvements to streamline operations.

Within the defined scope of responsibility, this position collaborates with various departments, vendor partners, and payers to establish effective processes, monitoring controls, and reporting mechanisms aimed at optimizing operational performance.

The SRBP is committed to supporting Boston Medical Center's core mission of delivering exceptional care without exception.

JOB REQUIREMENTS

EDUCATION:
Bachelor's degree in Business or a Healthcare-related field is preferred, or an equivalent combination of education and experience.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED :
None

EXPERIENCE:


A minimum of five years of experience in healthcare finance and Revenue Cycle management is required, ideally within an Academic Medical Center environment.

Extensive knowledge of policies, procedures, systems, and equipment related to revenue cycle operations, as well as regulations and guidelines for third-party payers and self-pay patients, is essential.

The ability to develop policies, procedures, and programs; analyze data; interpret statistics; create various reports including trend analyses; identify and resolve issues; and interpret guidelines and regulations is required.


KNOWLEDGE AND SKILLS:


This role requires strong interpersonal skills for effective team collaboration and relationship building across departments to support hospital objectives. The ability to maintain effective working relationships with all employees and act as a liaison to third-party representatives is critical.

Candidates must be able to work independently, manage time effectively, and handle multiple projects simultaneously.

Advanced problem management, process analysis, and root cause analysis skills are necessary.

Strong interviewing and listening skills are essential for engaging with individuals and groups to gather relevant information for process evaluation and solution identification.

Excellent communication skills, both verbal and written, are required to convey analysis, trends, and opportunities to stakeholders.

Proficiency in Windows-based software, including Microsoft Word, Outlook, Excel, and PowerPoint, is expected, along with strong presentation skills for interactions with senior management and physician leaders.
Organizational and project management skills are vital, as is the ability to respond promptly and maintain attention to detail.
Strategic thinking and superior analytical skills are essential for synthesizing information from multiple sources into actionable insights.
Familiarity with healthcare applications, including Epic and nThrive, is beneficial.

ESSENTIAL RESPONSIBILITIES / DUTIES:

General management responsibilities:


The Senior Revenue Cycle Business Partner aids in coordinating the activities of the HB and PB vendor liaison teams to achieve departmental goals, focusing on increasing cash collections by reducing insurance denials and managing patient account receivables.

This role involves interaction with BMC departments and external vendors and payer representatives to resolve account issues.

Documentation of processes among key internal stakeholders, including Case Management, Patient Access, Registration, and Coding, is essential to identify gaps and recommend policy and procedural changes for operational improvement.

Regular review, monitoring, and reporting on issues identified in Epic dashboards, particularly concerning claim edits and open account receivable balances, are required.
Conducting work queue reviews to ensure timely and accurate account management within service level agreements is critical.
Consistent monitoring of federal, state, and third-party payer regulations and guidelines, with updates communicated to all department stakeholders, is necessary.
Building and maintaining relationships with third-party payers is essential.
Demonstrating problem-solving capabilities and initiating necessary changes is expected. The SRBP develops, monitors, and utilizes reporting tools, monthly reports, and root cause analyses for denial management and outstanding accounts receivables.

Communication of denial trends and increases to senior leadership is vital to positively influence denial volumes.

Collaboration with ancillary departments and third-party payer representatives to identify denial sources and develop processes to minimize denials and enhance cash flow is required.

Maintaining clear communication channels for effective problem resolution related to denials and write-offs is essential.

Flexibility to adapt to departmental needs and prioritize multiple assignments is necessary.

Assisting in the training of employees within the Revenue Integrity denials department is also part of this role.

The Senior Revenue Cycle Business Partner performs all functions in compliance with standards set by Hospital Administration, Medical Staff, and regulatory agencies.

Engagement in continuous learning and a willingness to adopt new technologies and procedures is expected.

Additional duties may be assigned as required.
Systems, analysis, and reporting

Analyzing data and generating reports to identify focus areas, account resolutions, and overall unit effectiveness is essential.

Collecting accurate and timely information to create reports that highlight activity trends is required.

Identifying, reporting, and resolving issues related to all revenue cycle IT platforms, including Epic, FINThrive, Medicare FISS, Trizetto, and HealthRise, is necessary.

Reviewing operations and utilizing data to assess overall performance, team effectiveness, error rates, and system disconnects is part of the role. Preparing both ad hoc and standard reports to communicate interpretational analysis and recommending solutions within budgetary constraints is expected.
Professional conduct and personal development

Consistently demonstrating professionalism, courtesy, and a positive attitude in all communications and interactions with internal and external customers is vital. Collaborating to resolve service quality issues and other identified problems is essential. Representing the department at meetings and committees is expected.

Participation in decision-making processes on hospital-wide issues related to Revenue Cycle activities is part of the role.

The Senior Revenue Cycle Business Partner represents the department and the hospital positively.
Demonstrating focused written and verbal communication at all times is required, along with modeling the AIDET framework in appropriate contexts.

Responsibility for professional development to ensure knowledge of systems and advancements in billing and collection administration is expected.

Attendance at seminars and review of reports and publications from regulatory agencies and third-party payers is necessary to maintain knowledge of developments in the regulatory environment and billing practices. Identifying personal and professional growth areas and actively seeking ways to meet developmental needs is essential.

Utilizing the hospital's Core Purposes and Values as a decision-making framework to support PFS's contribution to the mission is expected.

IND123
Must adhere to all of BMC's RESPECT behavioral standards.
(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).
Equal Opportunity Employer/Disabled/Veterans

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