Director, Revenue Cycle (Project Management)

Job Summary:

• Provide leadership and strategic direction for direct and indirect revenue cycle functions.
• Demonstrate effective leadership by developing and defining vision, mission, customer service, business plans, and quality improvement activities and measures. Directs revenue cycle initiatives to build a compliant, comprehensive revenue cycle. Oversees coordination and standardization, work integration, change management, issue resolution, and measurement and communication related to revenue cycle initiative. Develops overall vision and implementation plans to effectively support organizational strategies requiring billing capability. Identifies and develops necessary infrastructure to support the implementation of strategies. Coordinates efforts with key functional units to establish organization-wide metrics, processes, procedures, templates, and collaborative tools to support the revenue cycle.
• Provide effective human resource management by providing, assessing, and teaching appropriate staff and promoting communication and feedback.
• Effectively manage information to meet the needs of the organizations by creating systems, analyzing data, and providing timely reporting.
• Direct and oversee the operations of patient access, PBX, Coding, Clinical Documentation Improvement Program, and Patient Financial Services including billing, follow-up, denials prevention, clinical appeals, payor contract, and reimbursement, managed care functions, revenue cycle integrity, and charge description master.
• Establish goals and matrices to measure the effectiveness of workflows and cash collections of patient accounts receivable.
• Works with other departments to enhance the efficiency of the revenue cycle process, the charge master, denials management, and reimbursement issues. 

EXPERIENCE/QUALIFICATIONS:

• Five (5) to ten (10) years of progressive experience in leadership in a health care environment or hospital, specifically in Revenue Cycle Operations
• Ability to analyze and resolve complex issues, both logical and interpersonal.
• Effective verbal and written communication skills and effective presentation skills.
• Leading and supporting Process Improvement and Change Management projects.
• Strong analytical skills and adeptness in interpreting strategic vision into an operational model.
• Proven leadership skills and experience managing a large department through well-established performance management skills.
• Business expertise, financial acumen and interpersonal skills to effectively work through a matriced, complex organization to influence and facilitate sustainable change.
• Technology and system savvy: excellent understanding of processes, systems, and databases.
• Well organized and disciplined, with the ability to manage multiple priorities and projects. Experience leading/participating in enterprise-wide projects and initiatives.
• Knowledgeable about the healthcare industry (e.g., managed care/revenue mgmt.) and translates that information into strategies that add value and improve operations.
• Outstanding written and oral communication skills; good listening capability; skilled at influencing a variety of people; can structure and effectively lead business meetings.
• Knowledge of accounting systems and insurance issues, healthcare industry issues and trends, legal issues in field of expertise, required third party and governmental guidelines, and work processing.
• Proficiency in Microsoft Office, including Outlook, Word, and Excel.

EDUCATION:

• Requires a bachelor's degree in Health, Business Administration or a related field or equivalent experience.
• A Master's degree in Health/Hospital Administration, Public Health, or Business Administration, or related field is required.

LICENSURES/CERTIFICATION:

• Must successfully complete and maintain LA City Fire Card certification at the time of hire or within the first 30 days of employment.

DUTIES AND RESPONSIBILITIES :

• Payroll, scheduling, training, counseling, evaluations, and disciplinary actions of accountable departments
• Responsible for an entire pipeline of charge capture activities from encounter form development and review to correct coding and oversight for ensuring accurate reimbursement for services billed. Responsible for driving process improvement initiatives related to front-end revenue cycle functions, in collaboration with the operations leadership and divisional managers.
• Oversees and provides input to ensure all systems are functional in categories such as dictionary file, data elements, interface and mapping, payer specificity, file transmission, billing area set, maintaining ICD‐10 and CPT codes, etc.
• Coordinates and facilitates compliance audits for the department. Directs internal compliance reviews conducted by the department coders. Provides feedback and education to physicians on coding errors for both procedure and E&M services. Verifies that fee schedules are appropriate against insurance payers' allowable fees.
• Serves as a key resource for changes in payment and coding guidelines from all payers. Educates and reeducates them on these continual updates. Responsible for constant and continual education of the physicians on coding changes.
• Analyzes monthly Appeals reports, tracking work efforts by the billing vendor to ensure collections activity regularly. Analyzes weekly charges and payments data to ensure the billing vendor is on track to meet established targets for productivity. Reviews EOBs as needed to determine/address payer problems. Coordinates efforts regarding authorization issues.
• Generates activity reports for the purpose of monitoring the accountable personnel and the efficiency of the revenue cycle processes.
• Benchmarks the ongoing accounts receivables and works with staff when key indicators show benchmarks are not being achieved.
• Monitors the unbilled accounts and works with all revenue cycle departments to minimize the unbilled accounts.
• Works with department managers to enhance reimbursement and decrease denials.
• Verifies accounts to be turned over to an outside collection agency.
• Assures compliance with regulatory agencies, licenses requirements and DNV. Updates departmental policies and procedures as necessary.
• Prepares budgets for accountable departments.
• Manages medical necessity compliance and financial policy compliance.
• Extends special attention and sensitivity to all patients, vendors, visitors, physicians and fellow employees.
• Assists in maintaining an atmosphere of cooperation with other departments and allied professionals.
• Demonstrates respect and cooperation in all staff relationships and a genuine willingness to prevent and resolve interpersonal conflicts.
• Demonstrates the ability to participate and/or implement team decisions.
• Demonstrates a willingness to act as a representative of the hospital and abide by the Valley Presbyterian Hospital's Code of Conduct.
• Actively participates in and encourages actions that promote good public relations with internal and external guests/customers within and across departmental and facility boundaries.
• Accepts change as an opportunity for growth, learning and development; adapts to changing procedures and goals in a cooperative and positive manner.
• Maintains confidentiality regarding patient, employee, and financial information.
• Handles difficult situations in a discreet and professional manner.
• Appearance is professional and in accordance with Valley Presbyterian Hospital's dress code.
• Completes and submits required employee documentation when due and no later than 30 days after the due date, including, but not limited to performance evaluations, re-verification of professional license, certification/registration, and/or CPR.
• Directs the management of all equipment located in the department. Responsible for maintaining the integrity of the equipment inventory by conducting periodic inventories, ensuring that control systems are in place to monitor equipment, validating receipt and required record keeping of new equipment, and following appropriate procedures when equipment is disposed of.
• Maintains departmental expenditures within acceptable limits.
• Directs the management of all supplies and supply inventories in the department. Assures that appropriate inventory levels are maintained and that control systems are in place to monitor systems. Purchases items in economic order quantities at the best possible price.

Salary Range: $76.66 - $117.20 per hour