Director, Hospital & Professional Billing & Chargemaster- Hybrid - The Christ Hospital Health Network

Job Description

The Christ Hospital Health Network (TCHHN) Director of Hospital/Professional Billing and Chargemaster is responsible for setting the strategic vision and directing, overseeing, ensuring, and coordinating post-service and chargemaster operations across the integrated healthcare system. Operations include but are not limited to: submission of claims and statements for payment, self-pay and insurance follow-up, denials and appeals, under-/over-payments, charging, revenue integrity and chargemaster, credits and refunds, payment posting, collections, and bad debt. In addition, this position has direct responsibility for quality and compliance activities within span of control and ensuring compliance with national and state law, payer requirements, and TCHHN policy.

Responsibilities

1. HB/PB Billing Operations and Chargemaster: Direct all post-service and chargemaster functions across the enterprise:

• Develop and deploy post-service and chargemaster systems as part of the TCHHN's overall Revenue Cycle systems plan.
• Monitor post-service and chargemaster systems and set TCHHN's standards for data quality and ethical practice.
• Lead in the development of post-service and chargemaster policies and procedures related, but not limited to, submission of claims and statements for payment, self-pay and insurance follow-up, denials and appeals, charging, revenue integrity and chargemaster, credits and refunds, payment posting, under-/over-payments, collections, and bad debt.
• Document compliance with and enforce Revenue Cycle's policies and procedures.
• Provide education and training to TCHHN employees in areas relevant to post-service and chargemaster policies and procedures.
• Ensure education on accurate and compliant charging practices.
• Monitor denial trends and conduct root cause analyses to identify denial improvement opportunities. Implement process improvements to reduce first pass and fatal denials. Track and report on the outcomes of interventions.
• Support and facilitate clinical, administrative, and external data use functions.
• Monitor local, national, and international trends in healthcare delivery.
• Monitor changes in legislation and accreditation standards that affect health information management.
• Serve as an internal consultant on topics within span of control.
• Plan and maintain a budget.
• Establish relationships with vendor representatives to ensure the efficient operation of outsourcing company's delivery commitments.
• Ensure all TCHHN patients and families receive a world-class financial experience.
• Coordinate up, down, across, and outside of TCHHN to ensure prompt, accurate, and compliant billing, charging, and collections practices.
• Provide expertise in post-service and chargemaster practices to maintain the integrity of TCHHN operations.
• Assist the TCHHN staff to ensure accurate documentation to support billing practices.
• Work with selected vendors and TCHHN Information Technology (IT) in troubleshooting system problems and maintaining system capabilities.
• Trend and analyze performance using data.
• Monitor in-house employees' productivity and monitor outsourced employees' productivity and turnaround times by work type.
• Direct and ensure appropriate post-service and chargemaster practices.
• Create programs to ensure optimal billing, collections, and chargemaster to support reimbursement is achieved.
• Ensure internal policies and procedures are maintained and updated as new services are implemented and regulations or requirements change.
• Compare reimbursement profile with national and regional standards to identify variations requiring further investigation.
• Monitor Medicare, AMA, and payer bulletins/manuals for pertinent changes to operations.
• Review the current OIG Work plans for risk areas and create plans to mitigate.
• Create and monitor dashboards and reports for in-scope units to identify patterns, trends, and variations in practices.
• Evaluate the causes of changes or problems and take appropriate steps in collaboration with the stakeholders to effect resolution.
• Communicate and work with Senior Leadership and Corporate Compliance to establish, maintain and provide leadership regarding post-service functions and reimbursement, and severity of illness.
• Monitor charging functions to ensure accuracy and compliance.
• Review claim denials and rejections pertaining to scope and, when necessary, implement processes, such as education programs, or modify current processes to prevent similar denials and rejections from recurring. Work with Payer Relations to escalate erroneous or questionable denials and rejections.
• Monitor clinical documentation and charging practices for appropriateness of services provided to the patient. Ensure documentation is present to support accurate charging and billing.
• Work with clinical staff to improve documentation.
• Continuously evaluate the quality of clinical documentation to spot incomplete or inconsistent documentation that impacts the code selection and payment. Identify and implement solutions.

2. Direct the ongoing transition of technology platforms:

• Forecast TCHHN's future technical needs to ensure compliance, prompt collections, and value for its customers.
• Partner with the Information Technology (IT) department to incorporate new technologies.
• Seek opportunities to translate the TCHHN strategic initiatives into an IT vision by keeping abreast of new technology to improve operations.
• Improve operations by developing processes that define leading practices for technical operational standards.
• Gain executive approval for IT investments.

3. Business Intelligence (BI)

• Guide performance from strategy through to frontline operations by giving the front-line information they need to know.
• Develop a BI model that is built around the needs of the organization.
• Design of a comprehensive program to lend support, analysis tools, and data necessary to make educated business decisions to hospital employees and management.
• Perform scientific and technical planning, direction, and analysis of selected BI systems used by management.
• Investigate existing national data and performing descriptive and analytic studies using statistical techniques.
• Provide ongoing data analysis to entity decision makers that are relevant to the healthcare market and assisting in problem solving, solution development, decision making, and strategic planning.

4. Unit Quality Initiative

• Develop, implement, and maintain standardized policies and procedures which:
  • Monitor the success of the post-service and chargemaster programs.
  • Review areas of risk.
  • Investigate identified issues.
  • Report data analyses.
  • Ensure compliance with external regulatory requirements.
  • Ensure consistency of quality data for the organization's internal data needs.
  • Identify, investigate, and prevent violations

5. Compliance leadership

• Establish, implement, and maintain a formalized review process for compliance, including an audit process.
• Assess current compliance activities, identify areas of high risk, and evaluate risk factors in areas within scope.
• Oversee and monitor implementation of a billing/chargemaster compliance program.
• Develop and coordinate educational and training programs on the results of auditing and monitoring activities to affected employees, providers, and leadership.
• Oversee internal investigations and review and act on reports of other potential problems.
• Approve corrective action to ensure resolution of problem areas identified during an internal investigation or auditing/monitoring activity.
• Report noncompliance issues detected through auditing and monitoring, the nature of corrective action plans implemented in response to identified problems, and results of follow-up audits to the corporate compliance officer.
• Receive and investigate reports of compliance violations and communicate this information to leadership and/or the corporate compliance officer.
• Approve disciplinary action for violation of the compliance program, the organization's standards of conduct, or policies and procedures.
• Ensure the appropriate dissemination and communication of all regulation, policy, and guideline changes to affected personnel.
• Serve as a resource for department managers, staff, physicians, and leadership to obtain information or clarification on accurate and ethical billing, charging, and collection practices documentation standards, guidelines, and payer and regulatory requirements.
• Monitor adherence to the compliance program.
• Revise the compliance program in response to changing organizational needs or new or revised regulations, policies, and guidelines.
• Recommend revisions to the corporate compliance program to improve its effectiveness.

Qualifications

Education:

• Bachelor's degree in Business, Finance, IT, HIM, Healthcare, or related field required.
• Master's degree in Business, Finance, IT, HIM, Healthcare, or related field preferred.

Years of Experience:

• 10 years' knowledge and experience in healthcare leadership required.
• 10 years' knowledge and experience in a combination of billing, collections, follow-up, charging, payment posting, denials management, chargemaster maintenance, underpayments is required.

Required Skills and Knowledge:

• Work collaboratively with customers to define and achieve common goals.
• Develop and maintain professional relationships with colleagues and staff within the department and organization to promote mutual understanding and respect.
• Work within the department, across the organization, and with clinical and senior leadership to meet organizational goals.
• Represent Revenue Cycle at institutional and policy making-level meetings, projects, activities, etc. as required.
• Demonstrate emotional intelligence in the approach to daily activities and challenges, both operating and with personnel.
• Think strategically and broadly when identifying issues and developing potential solutions. Use sound strategic thinking to determine the most efficient way to achieve desired objectives and in recommending options to situations without precedent.
• Demonstrate consistent use of Lean methodology for problem analysis and improvement.
• Demonstrate ability to manage multiple projects and work in a balanced manner to appropriately manage workload and assignments.
• Anticipate potential areas of concern and initiate tracking procedures and plans to mitigate.
• Lead multidisciplinary process improvement initiatives focused on identifying root causes and correcting improper or ineffective processes, improving compliance, and enhancing patient safety, data integrity, and staff competency.
• Demonstrated organization, facilitation, communication, and presentation skills required.
• Demonstrated experience in creating, following, and analyzing a departmental budget.
• Demonstrated experience and effectiveness in leading initiatives and projects.
• Demonstrated competency in the use of computer applications.
• Deliver high levels of initiative, drive and poise coupled with qualities of maturity, professionalism, flexibility, and patience.
• Hire and manage staff to achieve strategic objectives and maximum efficiencies.
• Communicate effectively at all levels-internally and externally-within the organization, and expressing ideas and information clearly and concisely, in verbal and written form.
• Actively contribute to the morale and teamwork of the staff and facility and always presenting a positive attitude and patient-minded vision, with patient satisfaction as the continuing goal.
• Excellent management and leadership skills with the ability to provide clear direction to the department and/or team while also functioning as an individual contributor.
• Leadership presence that establishes credibility at the highest levels of the organization, as well as across and down the organization with system users.
• Ability to attract, develop, deploy and retain teams and processes capable of maintaining a level of high performance while evolving with the organization.
• Outstanding communication skills with a demonstrated ability to connect with people on business needs, infrastructure issue resolution, projects and financial issues.
• Demonstrate a commitment to the highest standards of performance within time and budget constraints.